- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.14 / $5,621.00 / $9,870.00
| Facility | | $510.14 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.93 / $5,663.06 / $9,815.46
| Facility | | $1,716.93 | $5,663.06 | $9,815.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,774.26 / $2,279.96
| Facility | | $505.00 | $1,774.26 | $2,279.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.38 / $576.00 / $966.19
| Facility | | $419.38 | $576.00 | $966.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |