- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.36 / $4,230.00 / $9,727.00
| Facility | | $283.36 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,713.16 / $6,189.26 / $10,605.01
| Facility | | $2,713.16 | $6,189.26 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.00 / $505.00 / $2,581.96
| Facility | | $465.00 | $505.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.06 / $510.81 / $846.16
| Facility | | $275.06 | $510.81 | $846.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,878.00 / $16,772.00
| Facility | | $1,550.00 | $10,878.00 | $16,772.00 |