- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.28 / $1,702.06 / $5,634.00
| Facility | | $662.28 | $1,702.06 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.40 / $10,288.00 / $26,304.00
| Facility | | $1,852.40 | $10,288.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.09 / $908.84 / $1,363.26
| Facility | | $714.09 | $908.84 | $1,363.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.62 / $4,140.62 / $4,908.29
| Facility | | $4,140.62 | $4,140.62 | $4,908.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,649.00
| Facility | | $5,058.00 | $12,330.00 | $17,649.00 |