- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.00 / $9,544.15 / $20,928.72
| Facility | | $824.00 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.00 / $1,442.00 / $8,816.00
| Facility | | $824.00 | $1,442.00 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.68 / $2,055.98 / $2,811.48
| Facility | | $1,053.68 | $2,055.98 | $2,811.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,178.00 / $8,816.00
| Facility | | $5,341.00 | $6,178.00 | $8,816.00 |