- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.98 / $5,866.00 / $16,467.00
| Facility | | $896.98 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.64 / $4,773.22 / $8,868.89
| Facility | | $1,732.64 | $4,773.22 | $8,868.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.06 / $1,740.00 / $18,606.06
| Facility | | $882.06 | $1,740.00 | $18,606.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.53 / $896.98 / $1,686.04
| Facility | | $780.53 | $896.98 | $1,686.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,628.00 / $17,146.00 / $24,161.00
| Facility | | $4,628.00 | $17,146.00 | $24,161.00 |