- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.19 / $5,866.00 / $16,467.00
| Facility | | $886.19 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,823.26 / $5,808.35 / $9,674.06
| Facility | | $2,823.26 | $5,808.35 | $9,674.06 |
- 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
- $511.00 / $736.05 / $1,196.35
| Facility | | $511.00 | $736.05 | $1,196.35 |
- 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 |