- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.10 / $4,028.21 / $14,063.00
| Facility | | $944.10 | $4,028.21 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,611.00 / $14,400.00 / $33,821.32
| Facility | | $2,611.00 | $14,400.00 | $33,821.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.84 / $1,284.50 / $1,926.75
| Facility | | $974.84 | $1,284.50 | $1,926.75 |
- 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 |