- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.30 / $1,457.91 / $10,985.00
| Facility | | $933.30 | $1,457.91 | $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
- $862.67 / $1,121.47 / $1,294.01
| Facility | | $862.67 | $1,121.47 | $1,294.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,108.33
| Facility | | $761.00 | $761.00 | $1,108.33 |
- 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 |