- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.26 / $2,313.08 / $16,467.00
| Facility | | $970.26 | $2,313.08 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $953.81
| Facility | | $890.00 | $890.00 | $953.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.26 / $1,212.83 / $1,898.80
| Facility | | $970.26 | $1,212.83 | $1,898.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,628.00 / $19,766.00 / $25,620.00
| Facility | | $4,628.00 | $19,766.00 | $25,620.00 |