- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.96 / $5,866.00 / $16,467.00
| Facility | | $722.96 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,342.79 / $6,861.51 / $12,097.16
| Facility | | $3,342.79 | $6,861.51 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $721.28 / $2,581.96
| Facility | | $505.00 | $721.28 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.00 / $867.55 / $1,368.05
| Facility | | $649.00 | $867.55 | $1,368.05 |
- 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 |