- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.35 / $5,866.00 / $16,467.00
| Facility | | $456.35 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,483.92 / $4,694.54 / $7,666.70
| Facility | | $2,483.92 | $4,694.54 | $7,666.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,677.54
| Facility | | $505.00 | $505.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.03 / $427.06 / $643.04
| Facility | | $336.03 | $427.06 | $643.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |