- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.85 / $7,799.00 / $16,639.00
| Facility | | $580.85 | $7,799.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.80 / $5,908.67 / $10,140.68
| Facility | | $2,251.80 | $5,908.67 | $10,140.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,106.17 / $2,706.47
| Facility | | $2,106.17 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.72 / $672.00 / $1,054.64
| Facility | | $493.72 | $672.00 | $1,054.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |