- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.55 / $9,863.00 / $16,467.00
| Facility | | $856.55 | $9,863.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.54 / $10,783.42 / $18,360.62
| Facility | | $5,109.54 | $10,783.42 | $18,360.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $852.89 / $5,740.31
| Facility | | $580.00 | $852.89 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.73 / $1,027.85 / $1,631.15
| Facility | | $808.73 | $1,027.85 | $1,631.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |