- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.28 / $5,123.64 / $14,644.00
| Facility | | $417.28 | $5,123.64 | $14,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,238.87 / $10,927.34 / $20,194.91
| Facility | | $5,238.87 | $10,927.34 | $20,194.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,639.40 / $3,639.40 / $4,676.68
| Facility | | $3,639.40 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.28 / $3,381.57 / $7,181.98
| Facility | | $417.28 | $3,381.57 | $7,181.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,877.00 / $17,186.00 / $24,729.00
| Facility | | $8,877.00 | $17,186.00 | $24,729.00 |