- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.70 / $4,846.00 / $17,639.66
| Facility | | $682.70 | $4,846.00 | $17,639.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $7,833.00 / $14,645.00
| Facility | | $2,807.00 | $7,833.00 | $14,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.45 / $933.95 / $1,400.93
| Facility | | $680.45 | $933.95 | $1,400.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |