- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.08 / $5,866.00 / $16,467.00
| Facility | | $519.08 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,766.58 / $6,189.26 / $10,605.01
| Facility | | $2,766.58 | $6,189.26 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $520.78 / $2,581.96
| Facility | | $505.00 | $520.78 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.79 / $608.75 / $969.24
| Facility | | $437.79 | $608.75 | $969.24 |
- 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 |