- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.13 / $1,520.00 / $3,728.00
| Facility | | $293.13 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,338.56 / $4,441.93 / $6,777.62
| Facility | | $2,338.56 | $4,441.93 | $6,777.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $156.41 / $1,805.28
| Facility | | $40.00 | $156.41 | $1,805.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.81 / $525.00 / $2,599.03
| Facility | | $209.81 | $525.00 | $2,599.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,429.00 / $4,010.00
| Facility | | $464.00 | $1,429.00 | $4,010.00 |