- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.19 / $7,993.00 / $12,747.44
| Facility | | $939.19 | $7,993.00 | $12,747.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,135.79
| Facility | | $606.10 | $606.10 | $8,135.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.19 / $1,211.09 / $1,750.91
| Facility | | $939.19 | $1,211.09 | $1,750.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,317.00 / $13,946.00 / $19,832.00
| Facility | | $4,317.00 | $13,946.00 | $19,832.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $23,468.16 / $26,887.30
| Facility | | $55.00 | $23,468.16 | $26,887.30 |