- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.76 / $4,846.00 / $12,336.58
| Facility | | $808.76 | $4,846.00 | $12,336.58 |
- 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
- $639.24 / $814.72 / $940.07
| Facility | | $639.24 | $814.72 | $940.07 |
- 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 |