- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.33 / $4,790.10 / $11,025.00
| Facility | | $836.33 | $4,790.10 | $11,025.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.77 / $3,952.72 / $7,710.91
| Facility | | $1,822.77 | $3,952.72 | $7,710.91 |
- 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
- $310.08 / $409.14 / $714.54
| Facility | | $310.08 | $409.14 | $714.54 |
- 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 |