- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.32 / $1,580.32 / $9,727.00
| Facility | | $587.32 | $1,580.32 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,287.88 / $5,819.33 / $9,815.46
| Facility | | $2,287.88 | $5,819.33 | $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
- $523.92 / $781.00 / $1,178.15
| Facility | | $523.92 | $781.00 | $1,178.15 |
- 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 |