- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.02 / $3,776.00 / $9,870.00
| Facility | | $612.02 | $3,776.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,304.45 / $10,605.01
| Facility | | $2,866.56 | $6,304.45 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $618.24 / $2,581.96
| Facility | | $580.00 | $618.24 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.35 / $701.00 / $1,157.58
| Facility | | $537.35 | $701.00 | $1,157.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $9,904.00 / $16,249.00
| Facility | | $1,550.00 | $9,904.00 | $16,249.00 |