- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.78 / $4,376.00 / $16,975.77
| Facility | | $883.78 | $4,376.00 | $16,975.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $530.04
| Facility | | $530.04 | $530.04 | $530.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.00 / $1,029.48 / $1,637.44
| Facility | | $846.00 | $1,029.48 | $1,637.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,670.11 / $17,132.00
| Facility | | $55.00 | $14,670.11 | $17,132.00 |