- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.46 / $9,622.00 / $18,276.00
| Facility | | $802.46 | $9,622.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.58 / $9,413.49 / $16,208.45
| Facility | | $3,608.58 | $9,413.49 | $16,208.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,829.28 / $3,829.28 / $4,920.68
| Facility | | $3,829.28 | $3,829.28 | $4,920.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.83 / $939.56 / $1,392.54
| Facility | | $611.83 | $939.56 | $1,392.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |