- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.01 / $4,375.00 / $16,467.00
| Facility | | $789.01 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.87 / $5,205.85 / $8,705.65
| Facility | | $2,453.87 | $5,205.85 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $580.00 / $2,581.96
| Facility | | $375.00 | $580.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.00 / $786.00 / $1,222.97
| Facility | | $558.00 | $786.00 | $1,222.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |