- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.04 / $4,375.00 / $16,467.00
| Facility | | $728.04 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.84 / $3,640.46 / $6,138.71
| Facility | | $1,753.84 | $3,640.46 | $6,138.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $580.00 / $1,370.63
| Facility | | $375.00 | $580.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.04 / $829.25 / $1,376.45
| Facility | | $622.04 | $829.25 | $1,376.45 |
- 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 |