- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.40 / $5,107.20 / $9,727.00
| Facility | | $679.40 | $5,107.20 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.87 / $5,252.82 / $8,656.01
| Facility | | $2,453.87 | $5,252.82 | $8,656.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $678.87 / $2,581.96
| Facility | | $505.00 | $678.87 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.69 / $822.07 / $1,285.70
| Facility | | $652.69 | $822.07 | $1,285.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,878.00 / $16,772.00
| Facility | | $1,550.00 | $10,878.00 | $16,772.00 |