- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.82 / $1,386.00 / $16,042.00
| Facility | | $892.82 | $1,386.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $24,214.00 / $45,778.00
| Facility | | $2,575.00 | $24,214.00 | $45,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.21 / $1,060.66 / $1,223.83
| Facility | | $832.21 | $1,060.66 | $1,223.83 |
- 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 / $10,855.00 / $17,380.00
| Facility | | $5,431.00 | $10,855.00 | $17,380.00 |