- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.29 / $8,783.00 / $16,467.00
| Facility | | $479.29 | $8,783.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.00 / $5,391.80 / $9,227.19
| Facility | | $2,370.00 | $5,391.80 | $9,227.19 |
- 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
- $372.00 / $497.95 / $822.05
| Facility | | $372.00 | $497.95 | $822.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.00 / $10,147.00 / $16,816.00
| Facility | | $2,764.00 | $10,147.00 | $16,816.00 |