- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.74 / $4,375.00 / $16,467.00
| Facility | | $482.74 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,871.55 / $4,006.27 / $6,738.82
| Facility | | $1,871.55 | $4,006.27 | $6,738.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $480.98 / $2,581.96
| Facility | | $375.00 | $480.98 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.22 / $574.46 / $925.23
| Facility | | $462.22 | $574.46 | $925.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |