- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.62 / $4,230.00 / $9,727.00
| Facility | | $477.62 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.86 / $5,309.27 / $9,112.02
| Facility | | $2,460.86 | $5,309.27 | $9,112.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $702.60 / $1,965.14
| Facility | | $505.00 | $702.60 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.00 / $677.14 / $1,056.00
| Facility | | $474.00 | $677.14 | $1,056.00 |
- 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 |