- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.26 / $8,783.00 / $16,639.00
| Facility | | $690.26 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,871.55 / $3,989.66 / $6,725.20
| Facility | | $1,871.55 | $3,989.66 | $6,725.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $682.63 / $1,370.63
| Facility | | $580.00 | $682.63 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.11 / $818.24 / $1,320.62
| Facility | | $606.11 | $818.24 | $1,320.62 |
- 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 |