- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.44 / $5,621.00 / $9,870.00
| Facility | | $988.44 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.52 / $5,779.34 / $10,022.01
| Facility | | $2,202.52 | $5,779.34 | $10,022.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,711.96 / $4,769.93
| Facility | | $505.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.00 / $1,048.32 / $1,907.96
| Facility | | $798.00 | $1,048.32 | $1,907.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |