- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.96 / $10,087.00 / $15,411.45
| Facility | | $726.96 | $10,087.00 | $15,411.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $2,710.28
| Facility | | $852.10 | $852.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $871.72 / $1,339.30
| Facility | | $687.00 | $871.72 | $1,339.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $7,162.00 / $10,397.00
| Facility | | $1,711.00 | $7,162.00 | $10,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,801.20 / $8,957.00 / $26,542.00
| Facility | | $2,801.20 | $8,957.00 | $26,542.00 |