- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.36 / $5,866.00 / $16,467.00
| Facility | | $653.36 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.50 / $7,206.40 / $12,097.16
| Facility | | $3,294.50 | $7,206.40 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $652.83 / $2,581.96
| Facility | | $505.00 | $652.83 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.49 / $806.00 / $1,242.24
| Facility | | $625.49 | $806.00 | $1,242.24 |
- 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 |