- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.17 / $2,098.01 / $16,467.00
| Facility | | $678.17 | $2,098.01 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.95 / $4,957.82 / $8,588.78
| Facility | | $2,001.95 | $4,957.82 | $8,588.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $2,581.96
| Facility | | $580.00 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.72 / $877.00 / $1,454.18
| Facility | | $655.72 | $877.00 | $1,454.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |