- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.25 / $3,356.00 / $9,727.00
| Facility | | $311.25 | $3,356.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,476.67 / $5,267.76 / $8,842.83
| Facility | | $2,476.67 | $5,267.76 | $8,842.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,965.14
| Facility | | $505.00 | $505.00 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.56 / $401.03 / $566.49
| Facility | | $270.56 | $401.03 | $566.49 |
- 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 |