- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.51 / $8,716.00 / $16,467.00
| Facility | | $658.51 | $8,716.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.51 / $7,266.32 / $12,668.74
| Facility | | $2,820.51 | $7,266.32 | $12,668.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $2,144.17 / $2,755.30
| Facility | | $815.00 | $2,144.17 | $2,755.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.00 / $692.19 / $1,126.33
| Facility | | $520.00 | $692.19 | $1,126.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,114.00 / $12,798.00 / $23,771.00
| Facility | | $5,114.00 | $12,798.00 | $23,771.00 |