- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.39 / $6,653.00 / $9,637.10
| Facility | | $880.39 | $6,653.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $11,567.00 / $17,833.11
| Facility | | $8,407.00 | $11,567.00 | $17,833.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $4,326.79 / $4,326.79
| Facility | | $843.00 | $4,326.79 | $4,326.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,302.00 / $4,390.00 / $4,645.51
| Facility | | $4,302.00 | $4,390.00 | $4,645.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,325.00 / $8,043.00 / $11,880.00
| Facility | | $5,325.00 | $8,043.00 | $11,880.00 |