- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.17 / $2,838.15 / $11,674.00
| Facility | | $741.17 | $2,838.15 | $11,674.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.33 / $6,149.07 / $10,500.74
| Facility | | $2,330.33 | $6,149.07 | $10,500.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $846.64 / $2,581.96
| Facility | | $580.00 | $846.64 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.72 / $763.28 / $1,244.95
| Facility | | $487.72 | $763.28 | $1,244.95 |
- 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 |