- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.64 / $2,441.86 / $11,093.00
| Facility | | $921.64 | $2,441.86 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,200.00 / $15,727.00
| Facility | | $3,473.00 | $7,200.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.37 / $1,176.83 / $1,357.89
| Facility | | $923.37 | $1,176.83 | $1,357.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $3,909.74
| Facility | | $3,909.74 | $3,909.74 | $3,909.74 |
- 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 |