- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.52 / $2,422.19 / $16,467.00
| Facility | | $790.52 | $2,422.19 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.21 / $5,405.49 / $8,981.33
| Facility | | $2,709.21 | $5,405.49 | $8,981.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $1,604.11
| Facility | | $580.00 | $580.00 | $1,604.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.75 / $873.54 / $1,277.75
| Facility | | $684.75 | $873.54 | $1,277.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,607.00 / $8,667.00
| Facility | | $659.00 | $6,607.00 | $8,667.00 |