- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.92 / $3,514.59 / $16,467.00
| Facility | | $599.92 | $3,514.59 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.84 / $5,853.24 / $10,114.27
| Facility | | $2,149.84 | $5,853.24 | $10,114.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,106.17 / $2,706.47
| Facility | | $580.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.79 / $668.09 / $1,077.51
| Facility | | $478.79 | $668.09 | $1,077.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,918.00 / $16,786.68
| Facility | | $1,981.00 | $10,918.00 | $16,786.68 |