- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.75 / $1,386.00 / $11,093.00
| Facility | | $520.75 | $1,386.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $10,300.00 / $21,000.00
| Facility | | $1,614.00 | $10,300.00 | $21,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.84 / $550.38 / $635.05
| Facility | | $431.84 | $550.38 | $635.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,907.82 / $2,907.82 / $2,907.82
| Facility | | $2,907.82 | $2,907.82 | $2,907.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |