- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.21 / $6,548.00 / $16,467.00
| Facility | | $815.21 | $6,548.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,863.08 / $10,337.65 / $17,877.47
| Facility | | $4,863.08 | $10,337.65 | $17,877.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $812.52 / $5,740.31
| Facility | | $580.00 | $812.52 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.16 / $841.99 / $1,570.91
| Facility | | $693.16 | $841.99 | $1,570.91 |
- 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 |