- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.21 / $4,846.00 / $21,603.84
| Facility | | $842.21 | $4,846.00 | $21,603.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.00 / $11,989.00 / $43,260.00
| Facility | | $3,350.00 | $11,989.00 | $43,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.29 / $1,053.11 / $1,215.14
| Facility | | $826.29 | $1,053.11 | $1,215.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,561.47 / $6,561.47 / $6,561.47
| Facility | | $6,561.47 | $6,561.47 | $6,561.47 |
- 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 |