- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.25 / $8,783.00 / $16,639.00
| Facility | | $920.25 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,347.67 / $6,299.51 / $10,537.94
| Facility | | $3,347.67 | $6,299.51 | $10,537.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $2,594.85
| Facility | | $580.00 | $580.00 | $2,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.00 / $808.46 / $1,242.33
| Facility | | $576.00 | $808.46 | $1,242.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $12,456.00 / $19,591.00
| Facility | | $1,779.00 | $12,456.00 | $19,591.00 |