- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.43 / $4,846.00 / $14,063.00
| Facility | | $923.43 | $4,846.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,611.00 / $14,400.00 / $33,555.00
| Facility | | $2,611.00 | $14,400.00 | $33,555.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.78 / $1,260.70 / $1,891.05
| Facility | | $956.78 | $1,260.70 | $1,891.05 |
- 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 |