- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.99 / $1,850.00 / $3,813.00
| Facility | | $525.99 | $1,850.00 | $3,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,415.20 / $6,541.42 / $10,466.95
| Facility | | $3,415.20 | $6,541.42 | $10,466.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $305.23 / $2,807.66
| Facility | | $40.00 | $305.23 | $2,807.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.25 / $731.00 / $4,042.13
| Facility | | $582.25 | $731.00 | $4,042.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |