- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.33 / $5,866.00 / $16,467.00
| Facility | | $812.33 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.49 / $5,762.93 / $9,670.36
| Facility | | $2,709.49 | $5,762.93 | $9,670.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,677.54
| Facility | | $505.00 | $505.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.00 / $782.87 / $1,144.64
| Facility | | $566.00 | $782.87 | $1,144.64 |
- 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 |