- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.04 / $8,783.00 / $16,639.00
| Facility | | $586.04 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.92 / $4,890.35 / $7,789.04
| Facility | | $2,160.92 | $4,890.35 | $7,789.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $598.75 / $890.00
| Facility | | $580.00 | $598.75 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.49 / $588.07 / $1,108.02
| Facility | | $508.49 | $588.07 | $1,108.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.00 / $1,172.70 / $2,357.00
| Facility | | $384.00 | $1,172.70 | $2,357.00 |