- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.80 / $4,230.00 / $9,870.00
| Facility | | $520.80 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.73 / $3,989.66 / $6,725.20
| Facility | | $1,753.73 | $3,989.66 | $6,725.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $519.66 / $1,370.63
| Facility | | $505.00 | $519.66 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.10 / $624.97 / $987.14
| Facility | | $495.10 | $624.97 | $987.14 |
- 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 |