- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.65 / $4,230.00 / $9,727.00
| Facility | | $333.65 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,308.63 / $5,057.09 / $8,656.54
| Facility | | $2,308.63 | $5,057.09 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.55 / $505.00 / $2,581.96
| Facility | | $501.55 | $505.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.65 / $527.04 / $846.85
| Facility | | $333.65 | $527.04 | $846.85 |
- 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 |