- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.22 / $9,062.00 / $18,276.00
| Facility | | $908.22 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,860.32 / $10,437.45 / $18,018.52
| Facility | | $4,860.32 | $10,437.45 | $18,018.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $903.92 / $7,610.94
| Facility | | $715.00 | $903.92 | $7,610.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.28 / $1,191.00 / $1,730.28
| Facility | | $868.28 | $1,191.00 | $1,730.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |