- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.05 / $2,050.16 / $14,644.00
| Facility | | $496.05 | $2,050.16 | $14,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,252.64 / $7,306.28 / $11,947.84
| Facility | | $3,252.64 | $7,306.28 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.64 / $2,345.00 / $2,581.96
| Facility | | $734.64 | $2,345.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.05 / $2,050.16 / $3,177.75
| Facility | | $496.05 | $2,050.16 | $3,177.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $13,190.00 / $19,665.00
| Facility | | $2,155.00 | $13,190.00 | $19,665.00 |