- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.05 / $5,889.25 / $16,467.00
| Facility | | $715.05 | $5,889.25 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,871.55 / $3,809.31 / $6,700.72
| Facility | | $1,871.55 | $3,809.31 | $6,700.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.84 / $715.00 / $1,370.63
| Facility | | $709.84 | $715.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.14 / $835.29 / $1,241.56
| Facility | | $617.14 | $835.29 | $1,241.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |