- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.87 / $4,230.00 / $9,727.00
| Facility | | $725.87 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.23 / $6,184.58 / $10,605.01
| Facility | | $2,280.23 | $6,184.58 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $722.76 / $5,740.31
| Facility | | $505.00 | $722.76 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.00 / $870.80 / $1,378.74
| Facility | | $661.00 | $870.80 | $1,378.74 |
- 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 |