- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.87 / $4,375.00 / $16,467.00
| Facility | | $188.87 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.84 / $3,604.57 / $6,096.79
| Facility | | $1,753.84 | $3,604.57 | $6,096.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.37 / $375.00 / $2,581.96
| Facility | | $186.37 | $375.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.89 / $234.59 / $375.18
| Facility | | $185.89 | $234.59 | $375.18 |
- 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 |