- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.88 / $1,361.79 / $4,846.00
| Facility | | $529.88 | $1,361.79 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $10,300.00 / $21,000.00
| Facility | | $1,614.00 | $10,300.00 | $21,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.04 / $778.71 / $1,168.07
| Facility | | $571.04 | $778.71 | $1,168.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.73 / $2,605.73 / $2,605.73
| Facility | | $2,605.73 | $2,605.73 | $2,605.73 |
- 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 |