- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.45 / $1,926.34 / $12,615.00
| Facility | | $673.45 | $1,926.34 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $17,389.03
| Facility | | $852.10 | $852.10 | $17,389.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.45 / $942.00 / $1,443.78
| Facility | | $673.45 | $942.00 | $1,443.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,317.00 / $14,893.00 / $22,265.00
| Facility | | $4,317.00 | $14,893.00 | $22,265.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,556.84 / $50,159.68 / $57,467.65
| Facility | | $2,556.84 | $50,159.68 | $57,467.65 |