- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.46 / $1,410.00 / $12,615.00
| Facility | | $684.46 | $1,410.00 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $6,025.59
| Facility | | $852.10 | $852.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.46 / $939.20 / $1,486.12
| Facility | | $684.46 | $939.20 | $1,486.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,966.30 / $19,913.50 / $26,542.00
| Facility | | $3,966.30 | $19,913.50 | $26,542.00 |