- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.97 / $3,219.85 / $17,225.00
| Facility | | $864.97 | $3,219.85 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.00 / $11,294.00 / $22,813.00
| Facility | | $4,427.00 | $11,294.00 | $22,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.56 / $1,275.61 / $1,913.43
| Facility | | $903.56 | $1,275.61 | $1,913.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $3,909.74
| Facility | | $3,909.74 | $3,909.74 | $3,909.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |