- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.86 / $4,230.00 / $9,727.00
| Facility | | $509.86 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.18 / $4,037.34 / $6,619.00
| Facility | | $1,898.18 | $4,037.34 | $6,619.00 |
- 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
- $382.54 / $560.85 / $883.53
| Facility | | $382.54 | $560.85 | $883.53 |
- 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 |