- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.62 / $8,783.00 / $16,639.00
| Facility | | $981.62 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.14 / $3,376.25 / $5,721.68
| Facility | | $1,171.14 | $3,376.25 | $5,721.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,985.43 / $1,985.43 / $1,985.43
| Facility | | $1,985.43 | $1,985.43 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.50 / $1,048.31 / $1,218.95
| Facility | | $757.50 | $1,048.31 | $1,218.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,147.00 / $16,816.00
| Facility | | $1,981.00 | $10,147.00 | $16,816.00 |