- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.77 / $3,500.00 / $13,534.32
| Facility | | $631.77 | $3,500.00 | $13,534.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.00 / $9,314.00 / $16,615.00
| Facility | | $3,536.00 | $9,314.00 | $16,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.07 / $802.19 / $1,249.56
| Facility | | $617.07 | $802.19 | $1,249.56 |
- 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
- $5,431.00 / $12,330.00 / $17,416.00
| Facility | | $5,431.00 | $12,330.00 | $17,416.00 |