- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.16 / $2,318.00 / $11,093.00
| Facility | | $805.16 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,309.00 / $7,200.00 / $15,727.00
| Facility | | $3,309.00 | $7,200.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.42 / $1,010.65 / $1,166.13
| Facility | | $777.42 | $1,010.65 | $1,166.13 |
- 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
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |