- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.76 / $4,846.00 / $32,150.50
| Facility | | $701.76 | $4,846.00 | $32,150.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.00 / $14,400.00 / $33,821.32
| Facility | | $2,660.00 | $14,400.00 | $33,821.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.80 / $959.14 / $1,438.71
| Facility | | $698.80 | $959.14 | $1,438.71 |
- 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
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |