- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.56 / $8,783.00 / $16,639.00
| Facility | | $825.56 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,829.27 / $10,437.45 / $18,018.52
| Facility | | $4,829.27 | $10,437.45 | $18,018.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $826.87 / $5,740.31
| Facility | | $580.00 | $826.87 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.00 / $996.00 / $1,580.05
| Facility | | $779.00 | $996.00 | $1,580.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,628.00 / $20,341.00 / $27,446.00
| Facility | | $4,628.00 | $20,341.00 | $27,446.00 |