- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.26 / $1,386.00 / $10,985.00
| Facility | | $825.26 | $1,386.00 | $10,985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $989.34 / $1,141.55
| Facility | | $776.25 | $989.34 | $1,141.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $965.65
| Facility | | $761.00 | $761.00 | $965.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |