- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.43 / $2,318.00 / $14,063.00
| Facility | | $662.43 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.00 / $7,833.00 / $14,645.00
| Facility | | $3,536.00 | $7,833.00 | $14,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.02 / $885.32 / $1,327.98
| Facility | | $645.02 | $885.32 | $1,327.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,500.00 / $10,860.00 / $17,416.00
| Facility | | $5,500.00 | $10,860.00 | $17,416.00 |