- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.03 / $4,230.00 / $9,870.00
| Facility | | $445.03 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,304.45 / $10,605.01
| Facility | | $2,866.56 | $6,304.45 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.87 / $505.00 / $2,581.96
| Facility | | $447.87 | $505.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.00 / $482.00 / $770.97
| Facility | | $379.00 | $482.00 | $770.97 |
- 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 |