- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.73 / $3,815.00 / $13,335.00
| Facility | | $702.73 | $3,815.00 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,758.44 / $6,420.48 / $11,190.33
| Facility | | $2,758.44 | $6,420.48 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $696.06 / $2,581.96
| Facility | | $580.00 | $696.06 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.45 / $810.64 / $1,213.25
| Facility | | $605.45 | $810.64 | $1,213.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.00 / $12,269.00 / $19,591.00
| Facility | | $2,327.00 | $12,269.00 | $19,591.00 |