- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.27 / $5,866.00 / $16,467.00
| Facility | | $622.27 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,571.25 / $4,622.27 / $8,473.82
| Facility | | $1,571.25 | $4,622.27 | $8,473.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $621.95 / $1,965.14
| Facility | | $505.00 | $621.95 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.50 / $738.96 / $1,189.60
| Facility | | $542.50 | $738.96 | $1,189.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |