- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.91 / $9,622.00 / $18,276.00
| Facility | | $576.91 | $9,622.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,190.00 / $3,989.66 / $6,738.82
| Facility | | $2,190.00 | $3,989.66 | $6,738.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.83 / $1,130.00 / $2,581.96
| Facility | | $575.83 | $1,130.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.50 / $673.20 / $1,092.00
| Facility | | $511.50 | $673.20 | $1,092.00 |
- 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 |