- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.27 / $1,472.60 / $10,985.00
| Facility | | $941.27 | $1,472.60 | $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
- $871.36 / $1,132.77 / $1,307.04
| Facility | | $871.36 | $1,132.77 | $1,307.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,118.09
| Facility | | $761.00 | $761.00 | $1,118.09 |
- 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 |