- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.60 / $7,182.00 / $15,788.63
| Facility | | $743.60 | $7,182.00 | $15,788.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,858.03 / $7,168.58 / $12,337.09
| Facility | | $2,858.03 | $7,168.58 | $12,337.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,208.42 / $4,122.88
| Facility | | $505.00 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.13 / $817.96 / $1,335.26
| Facility | | $596.13 | $817.96 | $1,335.26 |
- 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 |