- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.45 / $1,921.25 / $16,467.00
| Facility | | $812.45 | $1,921.25 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,655.25 / $8,111.05 / $17,077.74
| Facility | | $2,655.25 | $8,111.05 | $17,077.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.51 / $806.51 / $890.00
| Facility | | $806.51 | $806.51 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.51 / $1,009.63 / $1,580.81
| Facility | | $809.51 | $1,009.63 | $1,580.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |