- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.16 / $5,355.00 / $10,817.74
| Facility | | $819.16 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,287.00 / $14,996.00
| Facility | | $1,712.00 | $3,287.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.28 / $466.28 / $678.98
| Facility | | $466.28 | $466.28 | $678.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,920.00 / $7,847.00
| Facility | | $2,840.00 | $5,920.00 | $7,847.00 |