- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.93 / $1,984.28 / $16,467.00
| Facility | | $852.93 | $1,984.28 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,189.26 / $10,500.74
| Facility | | $2,866.56 | $6,189.26 | $10,500.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $849.24 / $2,581.96
| Facility | | $815.00 | $849.24 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.00 / $854.14 / $1,627.32
| Facility | | $644.00 | $854.14 | $1,627.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $9,904.00 / $16,249.00
| Facility | | $1,550.00 | $9,904.00 | $16,249.00 |