- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.03 / $3,500.00 / $16,042.00
| Facility | | $789.03 | $3,500.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.00 / $10,182.00 / $16,615.00
| Facility | | $3,390.00 | $10,182.00 | $16,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.54 / $1,079.57 / $1,619.36
| Facility | | $786.54 | $1,079.57 | $1,619.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,682.40 / $2,682.40 / $3,179.73
| Facility | | $2,682.40 | $2,682.40 | $3,179.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |