- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.01 / $4,800.17 / $17,225.00
| Facility | | $905.01 | $4,800.17 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,010.00 / $14,096.00 / $30,900.00
| Facility | | $5,010.00 | $14,096.00 | $30,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.02 / $1,238.06 / $1,857.09
| Facility | | $902.02 | $1,238.06 | $1,857.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- 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 |