- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.08 / $9,062.00 / $16,467.00
| Facility | | $962.08 | $9,062.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $4,471.00 / $7,943.74
| Facility | | $2,187.00 | $4,471.00 | $7,943.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,971.55 / $3,971.55 / $5,103.52
| Facility | | $3,971.55 | $3,971.55 | $5,103.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.96 / $1,104.95 / $1,846.96
| Facility | | $824.96 | $1,104.95 | $1,846.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |