- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.63 / $4,375.00 / $16,467.00
| Facility | | $856.63 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,808.51 / $8,455.28 / $14,361.26
| Facility | | $3,808.51 | $8,455.28 | $14,361.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.01 / $2,345.00 / $5,051.60
| Facility | | $847.01 | $2,345.00 | $5,051.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.24 / $856.63 / $1,636.48
| Facility | | $691.24 | $856.63 | $1,636.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |