- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.67 / $4,846.00 / $16,168.00
| Facility | | $743.67 | $4,846.00 | $16,168.00 |
- 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
- $738.49 / $1,013.61 / $1,520.42
| Facility | | $738.49 | $1,013.61 | $1,520.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,987.93 / $5,987.93 / $7,098.11
| Facility | | $5,987.93 | $5,987.93 | $7,098.11 |
- 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 |