- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.63 / $5,866.00 / $16,467.00
| Facility | | $653.63 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,806.94 / $6,017.26 / $9,892.90
| Facility | | $2,806.94 | $6,017.26 | $9,892.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $2,279.96
| Facility | | $505.00 | $505.00 | $2,279.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.77 / $708.35 / $980.44
| Facility | | $533.77 | $708.35 | $980.44 |
- 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 |