- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.74 / $4,375.00 / $16,467.00
| Facility | | $762.74 | $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 / $580.00 / $2,581.96
| Facility | | $375.00 | $580.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.19 / $897.35 / $1,328.40
| Facility | | $657.19 | $897.35 | $1,328.40 |
- 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 |