- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.06 / $3,072.84 / $14,063.00
| Facility | | $430.06 | $3,072.84 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,935.00 / $12,775.00 / $30,091.00
| Facility | | $1,935.00 | $12,775.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.03 / $767.57 / $915.17
| Facility | | $492.03 | $767.57 | $915.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,833.32 / $3,833.32 / $3,833.32
| Facility | | $3,833.32 | $3,833.32 | $3,833.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |