- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.40 / $4,470.00 / $12,769.64
| Facility | | $827.40 | $4,470.00 | $12,769.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,404.79 / $5,965.00 / $16,201.00
| Facility | | $2,404.79 | $5,965.00 | $16,201.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.00 / $9,841.00 / $14,444.00
| Facility | | $5,813.00 | $9,841.00 | $14,444.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.39 / $1,102.84 / $8,957.00
| Facility | | $643.39 | $1,102.84 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $2,993.00 / $7,042.00
| Facility | | $2,120.00 | $2,993.00 | $7,042.00 |