- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.58 / $3,847.00 / $14,088.24
| Facility | | $461.58 | $3,847.00 | $14,088.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $8,584.00 / $11,253.00
| Facility | | $4,755.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.02 / $587.47 / $677.69
| Facility | | $428.02 | $587.47 | $677.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.10 / $772.10 / $772.10
| Facility | | $772.10 | $772.10 | $772.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |