- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.55 / $7,799.00 / $16,639.00
| Facility | | $858.55 | $7,799.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,911.85 / $7,206.40 / $12,097.16
| Facility | | $2,911.85 | $7,206.40 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $847.01 / $5,740.31
| Facility | | $580.00 | $847.01 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.95 / $1,077.00 / $1,681.47
| Facility | | $843.95 | $1,077.00 | $1,681.47 |
- 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 |