- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.14 / $6,273.05 / $9,870.00
| Facility | | $816.14 | $6,273.05 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,151.53 / $6,852.09 / $11,947.84
| Facility | | $3,151.53 | $6,852.09 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $813.53 / $5,740.31
| Facility | | $780.00 | $813.53 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.79 / $939.47 / $1,544.21
| Facility | | $731.79 | $939.47 | $1,544.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |