- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.65 / $8,160.77 / $19,354.04
| Facility | | $771.65 | $8,160.77 | $19,354.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,174.00 / $11,249.00 / $30,091.00
| Facility | | $2,174.00 | $11,249.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.38 / $879.89 / $1,015.26
| Facility | | $690.38 | $879.89 | $1,015.26 |
- 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 |