- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.32 / $2,397.00 / $4,050.00
| Facility | | $447.32 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.09 / $7,360.79 / $13,753.10
| Facility | | $4,062.09 | $7,360.79 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.01 / $2,476.62 / $2,476.62
| Facility | | $237.01 | $2,476.62 | $2,476.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |