- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.38 / $7,720.00 / $9,889.00
| Facility | | $680.38 | $7,720.00 | $9,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.16 / $2,434.16 / $2,434.16
| Facility | | $2,434.16 | $2,434.16 | $2,434.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,052.00 / $3,052.00 / $3,571.00
| Facility | | $3,052.00 | $3,052.00 | $3,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.36 / $520.10 / $860.25
| Facility | | $405.36 | $520.10 | $860.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.00 / $6,427.00 / $12,199.00
| Facility | | $1,360.00 | $6,427.00 | $12,199.00 |