- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.82 / $8,783.00 / $16,639.00
| Facility | | $632.82 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,126.89 / $10,016.39 / $17,728.68
| Facility | | $4,126.89 | $10,016.39 | $17,728.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.41 / $2,021.41 / $2,597.55
| Facility | | $2,021.41 | $2,021.41 | $2,597.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.44 / $748.75 / $1,048.26
| Facility | | $505.44 | $748.75 | $1,048.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |