- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.70 / $2,350.35 / $16,467.00
| Facility | | $803.70 | $2,350.35 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,189.26 / $10,605.01
| Facility | | $2,866.56 | $6,189.26 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $8,233.00
| Facility | | $580.00 | $890.00 | $8,233.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.48 / $997.58 / $1,723.57
| Facility | | $781.48 | $997.58 | $1,723.57 |
- 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 |