- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.54 / $5,866.00 / $16,467.00
| Facility | | $590.54 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.39 / $5,205.85 / $8,705.65
| Facility | | $2,347.39 | $5,205.85 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $590.34 / $2,581.96
| Facility | | $505.00 | $590.34 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.52 / $699.90 / $1,114.11
| Facility | | $565.52 | $699.90 | $1,114.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |