- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.64 / $3,776.00 / $9,727.00
| Facility | | $605.64 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.87 / $5,205.85 / $8,724.34
| Facility | | $2,453.87 | $5,205.85 | $8,724.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $580.00 / $1,370.63
| Facility | | $375.00 | $580.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.74 / $823.00 / $1,313.14
| Facility | | $542.74 | $823.00 | $1,313.14 |
- 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 |