- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.44 / $1,520.00 / $3,685.00
| Facility | | $579.44 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,460.05 / $6,565.29 / $13,753.10
| Facility | | $3,460.05 | $6,565.29 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.23 / $6,008.18 / $6,008.18
| Facility | | $436.23 | $6,008.18 | $6,008.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |