- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.03 / $4,643.17 / $19,148.00
| Facility | | $945.03 | $4,643.17 | $19,148.00 |
- 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
- $937.22 / $1,286.38 / $1,929.57
| Facility | | $937.22 | $1,286.38 | $1,929.57 |
- 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
- $5,235.00 / $12,296.00 / $17,416.00
| Facility | | $5,235.00 | $12,296.00 | $17,416.00 |