- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.09 / $4,679.01 / $9,727.00
| Facility | | $683.09 | $4,679.01 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.77 / $6,836.09 / $12,212.57
| Facility | | $2,764.77 | $6,836.09 | $12,212.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $677.58 / $8,052.24
| Facility | | $505.00 | $677.58 | $8,052.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.26 / $683.09 / $1,246.09
| Facility | | $342.26 | $683.09 | $1,246.09 |
- 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 |