- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.58 / $4,725.00 / $16,467.00
| Facility | | $869.58 | $4,725.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.66 / $5,154.55 / $8,622.48
| Facility | | $2,413.66 | $5,154.55 | $8,622.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $868.22 / $1,370.63
| Facility | | $715.00 | $868.22 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.08 / $1,072.05 / $1,668.93
| Facility | | $842.08 | $1,072.05 | $1,668.93 |
- 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 |