- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.68 / $4,130.12 / $7,796.00
| Facility | | $403.68 | $4,130.12 | $7,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.00 / $4,216.76 / $7,801.39
| Facility | | $1,737.00 | $4,216.76 | $7,801.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.29 / $2,130.29 / $2,737.46
| Facility | | $2,130.29 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.86 / $192.96 / $352.78
| Facility | | $145.86 | $192.96 | $352.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |