- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.38 / $7,182.00 / $16,467.00
| Facility | | $524.38 | $7,182.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.86 / $2,685.72 / $5,289.80
| Facility | | $1,112.86 | $2,685.72 | $5,289.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $1,842.86
| Facility | | $375.00 | $615.00 | $1,842.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.91 / $593.04 / $889.13
| Facility | | $447.91 | $593.04 | $889.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |