- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.44 / $4,846.00 / $13,369.75
| Facility | | $764.44 | $4,846.00 | $13,369.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,200.00 / $15,727.00
| Facility | | $3,473.00 | $7,200.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.09 / $771.20 / $889.85
| Facility | | $605.09 | $771.20 | $889.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,033.31 / $4,033.31 / $4,033.31
| Facility | | $4,033.31 | $4,033.31 | $4,033.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |