- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.47 / $5,201.00 / $11,627.00
| Facility | | $972.47 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $3,025.00 / $8,800.00
| Facility | | $1,152.00 | $3,025.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.31 / $1,230.03 / $1,525.80
| Facility | | $1,003.31 | $1,230.03 | $1,525.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.45 / $1,124.08 / $21,571.00
| Facility | | $934.45 | $1,124.08 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.08 / $1,124.08 / $1,253.49
| Facility | | $1,124.08 | $1,124.08 | $1,253.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,321.00 / $7,351.00
| Facility | | $2,233.00 | $4,321.00 | $7,351.00 |