- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.98 / $1,854.00 / $16,042.00
| Facility | | $723.98 | $1,854.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.00 / $10,284.00 / $16,778.00
| Facility | | $3,536.00 | $10,284.00 | $16,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.14 / $924.20 / $1,066.38
| Facility | | $725.14 | $924.20 | $1,066.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |