- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.76 / $4,862.00 / $12,026.89
| Facility | | $855.76 | $4,862.00 | $12,026.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.50 / $6,273.95 / $10,965.64
| Facility | | $2,017.50 | $6,273.95 | $10,965.64 |
- 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
- $778.14 / $1,026.91 / $1,649.00
| Facility | | $778.14 | $1,026.91 | $1,649.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |