- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.54 / $4,846.00 / $11,093.00
| Facility | | $960.54 | $4,846.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,529.00 / $7,266.00 / $31,391.00
| Facility | | $3,529.00 | $7,266.00 | $31,391.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.40 / $1,308.58 / $1,962.89
| Facility | | $953.40 | $1,308.58 | $1,962.89 |
- 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
- $5,431.00 / $12,330.00 / $17,416.00
| Facility | | $5,431.00 | $12,330.00 | $17,416.00 |