- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.75 / $8,783.00 / $16,639.00
| Facility | | $502.75 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.50 / $6,861.51 / $12,097.16
| Facility | | $3,294.50 | $6,861.51 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.05 / $580.00 / $2,581.96
| Facility | | $504.05 | $580.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.00 / $702.00 / $1,171.00
| Facility | | $482.00 | $702.00 | $1,171.00 |
- 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 |