- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.76 / $4,846.00 / $18,376.84
| Facility | | $894.76 | $4,846.00 | $18,376.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $9,200.00 / $20,184.00
| Facility | | $1,411.35 | $9,200.00 | $20,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.10 / $1,220.33 / $1,830.51
| Facility | | $889.10 | $1,220.33 | $1,830.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,935.68 / $19,935.68 / $23,631.80
| Facility | | $19,935.68 | $19,935.68 | $23,631.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,649.00
| Facility | | $5,058.00 | $12,330.00 | $17,649.00 |