- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.76 / $8,783.00 / $16,639.00
| Facility | | $853.76 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,871.40 / $6,324.60 / $10,943.81
| Facility | | $2,871.40 | $6,324.60 | $10,943.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $3,424.28
| Facility | | $580.00 | $580.00 | $3,424.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.06 / $970.17 / $1,306.00
| Facility | | $698.06 | $970.17 | $1,306.00 |
- 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 |