- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.26 / $2,472.00 / $17,225.00
| Facility | | $736.26 | $2,472.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,601.00 / $8,240.00 / $17,829.00
| Facility | | $3,601.00 | $8,240.00 | $17,829.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.98 / $1,084.20 / $1,626.30
| Facility | | $767.98 | $1,084.20 | $1,626.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.80 / $1,868.80 / $1,868.80
| Facility | | $1,868.80 | $1,868.80 | $1,868.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |