- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.67 / $6,704.21 / $16,042.00
| Facility | | $825.67 | $6,704.21 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $10,288.00 / $26,304.00
| Facility | | $2,310.00 | $10,288.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.08 / $982.75 / $1,133.94
| Facility | | $771.08 | $982.75 | $1,133.94 |
- 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 |