- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.35 / $4,846.00 / $14,107.73
| Facility | | $422.35 | $4,846.00 | $14,107.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,650.00 / $40,050.00 / $63,916.00
| Facility | | $3,650.00 | $40,050.00 | $63,916.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.69 / $422.75 / $487.79
| Facility | | $331.69 | $422.75 | $487.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,720.33 / $17,720.33 / $17,720.33
| Facility | | $17,720.33 | $17,720.33 | $17,720.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,258.00 / $16,659.00 / $26,476.00
| Facility | | $8,258.00 | $16,659.00 | $26,476.00 |