- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.37 / $5,621.00 / $9,870.00
| Facility | | $747.37 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.35 / $9,528.23 / $16,900.34
| Facility | | $3,740.35 | $9,528.23 | $16,900.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,711.96 / $4,769.93
| Facility | | $505.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.65 / $693.43 / $1,276.54
| Facility | | $538.65 | $693.43 | $1,276.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |