- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.10 / $2,923.11 / $18,573.00
| Facility | | $320.10 | $2,923.11 | $18,573.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,935.00 / $17,528.00 / $30,091.00
| Facility | | $1,935.00 | $17,528.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.74 / $472.55 / $3,374.11
| Facility | | $339.74 | $472.55 | $3,374.11 |
- 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
- $5,051.00 / $11,452.00 / $17,416.00
| Facility | | $5,051.00 | $11,452.00 | $17,416.00 |