- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.03 / $2,520.00 / $6,681.00
| Facility | | $683.03 | $2,520.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.00 / $5,060.00 / $9,272.00
| Facility | | $1,963.00 | $5,060.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $2,277.00 / $4,038.10
| Facility | | $550.00 | $2,277.00 | $4,038.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,394.60 / $2,394.60 / $26,542.00
| Facility | | $2,394.60 | $2,394.60 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,351.00 / $6,285.00
| Facility | | $1,000.00 | $3,351.00 | $6,285.00 |