- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.33 / $3,821.00 / $12,600.00
| Facility | | $444.33 | $3,821.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,620.72 / $5,677.50 / $8,857.35
| Facility | | $3,620.72 | $5,677.50 | $8,857.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.14 / $480.68 / $5,558.80
| Facility | | $338.14 | $480.68 | $5,558.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |