- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.13 / $5,867.93 / $18,500.00
| Facility | | $684.13 | $5,867.93 | $18,500.00 |
- 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
- $567.32 / $723.06 / $834.30
| Facility | | $567.32 | $723.06 | $834.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,982.66 / $2,982.66 / $2,982.66
| Facility | | $2,982.66 | $2,982.66 | $2,982.66 |
- 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 |