- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.40 / $8,960.00 / $17,549.00
| Facility | | $814.40 | $8,960.00 | $17,549.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.02 / $8,187.77 / $14,361.26
| Facility | | $2,344.02 | $8,187.77 | $14,361.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $791.96 / $1,512.28
| Facility | | $715.00 | $791.96 | $1,512.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.72 / $940.37 / $1,509.12
| Facility | | $676.72 | $940.37 | $1,509.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |