- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.44 / $9,770.95 / $22,331.00
| Facility | | $543.44 | $9,770.95 | $22,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,159.04 / $28,619.73 / $49,542.56
| Facility | | $9,159.04 | $28,619.73 | $49,542.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,955.54 / $12,955.54 / $16,648.09
| Facility | | $12,955.54 | $12,955.54 | $16,648.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.44 / $1,307.00 / $1,935.51
| Facility | | $543.44 | $1,307.00 | $1,935.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $21,721.00 / $33,299.00
| Facility | | $3,340.00 | $21,721.00 | $33,299.00 |