- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.96 / $5,866.00 / $16,467.00
| Facility | | $651.96 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.00 / $5,154.55 / $8,705.65
| Facility | | $2,167.00 | $5,154.55 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $643.57 / $2,581.96
| Facility | | $505.00 | $643.57 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.79 / $768.00 / $1,259.02
| Facility | | $635.79 | $768.00 | $1,259.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.00 / $13,190.00 / $19,665.00
| Facility | | $2,327.00 | $13,190.00 | $19,665.00 |