- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.56 / $2,318.00 / $14,063.00
| Facility | | $770.56 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $9,219.00 / $30,900.00
| Facility | | $4,146.00 | $9,219.00 | $30,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.31 / $1,053.16 / $1,579.74
| Facility | | $767.31 | $1,053.16 | $1,579.74 |
- 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 |