- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.30 / $10,500.00 / $19,932.52
| Facility | | $579.30 | $10,500.00 | $19,932.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.98 / $5,983.28 / $10,398.95
| Facility | | $2,248.98 | $5,983.28 | $10,398.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.04 / $715.00 / $2,581.96
| Facility | | $581.04 | $715.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $579.30 / $1,096.58
| Facility | | $452.00 | $579.30 | $1,096.58 |
- 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 |