- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.09 / $4,375.00 / $16,467.00
| Facility | | $470.09 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.86 / $5,008.77 / $8,927.19
| Facility | | $2,460.86 | $5,008.77 | $8,927.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $471.30 / $1,965.14
| Facility | | $375.00 | $471.30 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.63 / $540.60 / $883.82
| Facility | | $414.63 | $540.60 | $883.82 |
- 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 |