- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.35 / $10,500.00 / $52,499.00
| Facility | | $661.35 | $10,500.00 | $52,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,102.50 / $5,636.89 / $9,721.67
| Facility | | $2,102.50 | $5,636.89 | $9,721.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $2,486.00 / $3,194.56
| Facility | | $2,486.00 | $2,486.00 | $3,194.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.72 / $745.57 / $1,138.26
| Facility | | $504.72 | $745.57 | $1,138.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |