- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,520.00 / $3,685.00
| Facility | | $443.91 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,011.68 / $5,856.90 / $9,228.77
| Facility | | $3,011.68 | $5,856.90 | $9,228.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $171.79 / $2,657.13
| Facility | | $40.00 | $171.79 | $2,657.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.28 / $525.00 / $3,825.42
| Facility | | $330.28 | $525.00 | $3,825.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $2,415.00 / $6,661.00
| Facility | | $689.00 | $2,415.00 | $6,661.00 |