- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.25 / $4,230.00 / $9,062.00
| Facility | | $936.25 | $4,230.00 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.13 / $3,135.91 / $7,126.88
| Facility | | $2,103.13 | $3,135.91 | $7,126.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.71 / $1,044.83 / $1,584.71
| Facility | | $786.71 | $1,044.83 | $1,584.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |