- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.51 / $8,783.00 / $16,639.00
| Facility | | $979.51 | $8,783.00 | $16,639.00 |
- 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
- $580.00 / $890.00 / $7,565.87
| Facility | | $580.00 | $890.00 | $7,565.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.99 / $1,057.82 / $1,848.48
| Facility | | $881.99 | $1,057.82 | $1,848.48 |
- 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 |