- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.97 / $5,585.30 / $12,358.00
| Facility | | $705.97 | $5,585.30 | $12,358.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $7,352.16 / $13,869.80
| Facility | | $515.00 | $7,352.16 | $13,869.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.48 / $6,041.67 / $10,057.08
| Facility | | $435.48 | $6,041.67 | $10,057.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.00 / $2,500.00 / $18,665.00
| Facility | | $1,717.00 | $2,500.00 | $18,665.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,271.16 / $10,271.16
| Facility | | $55.00 | $10,271.16 | $10,271.16 |