- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.47 / $5,866.00 / $16,467.00
| Facility | | $908.47 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.02 / $4,037.34 / $6,619.00
| Facility | | $2,153.02 | $4,037.34 | $6,619.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,985.43
| Facility | | $505.00 | $505.00 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.00 / $813.30 / $1,272.85
| Facility | | $559.00 | $813.30 | $1,272.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |