- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.85 / $5,621.00 / $9,870.00
| Facility | | $600.85 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,301.68 / $10,824.82 / $19,110.90
| Facility | | $4,301.68 | $10,824.82 | $19,110.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,639.40 / $4,676.68
| Facility | | $505.00 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.00 / $633.14 / $1,135.47
| Facility | | $457.00 | $633.14 | $1,135.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |