- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.66 / $2,472.00 / $17,225.00
| Facility | | $918.66 | $2,472.00 | $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
- $935.34 / $1,232.45 / $1,848.68
| Facility | | $935.34 | $1,232.45 | $1,848.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,019.60 / $6,019.60 / $7,135.65
| Facility | | $6,019.60 | $6,019.60 | $7,135.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |