- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.79 / $5,866.00 / $16,467.00
| Facility | | $625.79 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.02 / $4,270.28 / $6,980.19
| Facility | | $2,153.02 | $4,270.28 | $6,980.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,985.43 / $1,985.43 / $1,985.43
| Facility | | $1,985.43 | $1,985.43 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.95 / $677.15 / $923.57
| Facility | | $497.95 | $677.15 | $923.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,147.00 / $16,816.00
| Facility | | $1,981.00 | $10,147.00 | $16,816.00 |