- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.86 / $3,776.00 / $9,727.00
| Facility | | $210.86 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.81 / $5,095.07 / $8,656.54
| Facility | | $2,435.81 | $5,095.07 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.73 / $375.00 / $1,370.63
| Facility | | $312.73 | $375.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.86 / $408.74 / $686.36
| Facility | | $210.86 | $408.74 | $686.36 |
- 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 |