- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.05 / $1,981.60 / $29,003.52
| Facility | | $771.05 | $1,981.60 | $29,003.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $21,000.00
| Facility | | $2,796.00 | $6,340.00 | $21,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.56 / $1,123.16 / $1,684.74
| Facility | | $795.56 | $1,123.16 | $1,684.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,594.87 / $3,594.87 / $3,594.87
| Facility | | $3,594.87 | $3,594.87 | $3,594.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |