- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.07 / $5,192.00 / $9,870.00
| Facility | | $750.07 | $5,192.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.18 / $6,836.09 / $11,947.84
| Facility | | $2,803.18 | $6,836.09 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $745.45 / $2,581.96
| Facility | | $505.00 | $745.45 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.22 / $937.59 / $1,455.76
| Facility | | $727.22 | $937.59 | $1,455.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |