- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.09 / $4,846.00 / $17,560.20
| Facility | | $692.09 | $4,846.00 | $17,560.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,322.00 / $12,191.00 / $30,900.00
| Facility | | $4,322.00 | $12,191.00 | $30,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.94 / $951.26 / $1,426.89
| Facility | | $721.94 | $951.26 | $1,426.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,378.47 / $6,378.47 / $7,561.05
| Facility | | $6,378.47 | $6,378.47 | $7,561.05 |
- 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 |