- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.47 / $8,783.00 / $16,639.00
| Facility | | $738.47 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,154.44 / $6,537.29 / $11,190.33
| Facility | | $3,154.44 | $6,537.29 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $727.37 / $2,581.96
| Facility | | $580.00 | $727.37 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.65 / $878.78 / $1,277.30
| Facility | | $651.65 | $878.78 | $1,277.30 |
- 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 |