- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.68 / $1,854.00 / $16,042.00
| Facility | | $864.68 | $1,854.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.00 / $10,700.00 / $17,513.00
| Facility | | $3,719.00 | $10,700.00 | $17,513.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.94 / $1,096.00 / $1,264.61
| Facility | | $859.94 | $1,096.00 | $1,264.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,379.37 / $3,379.37 / $3,379.37
| Facility | | $3,379.37 | $3,379.37 | $3,379.37 |
- 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 |