- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.00 / $5,866.00 / $16,467.00
| Facility | | $686.00 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.39 / $5,205.85 / $8,724.34
| Facility | | $2,347.39 | $5,205.85 | $8,724.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $680.75 / $2,581.96
| Facility | | $505.00 | $680.75 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.12 / $823.20 / $1,340.88
| Facility | | $638.12 | $823.20 | $1,340.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,878.00 / $16,772.00
| Facility | | $1,550.00 | $10,878.00 | $16,772.00 |