- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.26 / $7,799.00 / $16,467.00
| Facility | | $710.26 | $7,799.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,835.02 / $10,374.89 / $18,314.23
| Facility | | $4,835.02 | $10,374.89 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $815.00 / $2,581.96
| Facility | | $709.00 | $815.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.00 / $840.83 / $1,343.66
| Facility | | $670.00 | $840.83 | $1,343.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |