- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.43 / $1,850.00 / $5,607.00
| Facility | | $371.43 | $1,850.00 | $5,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $4,077.94 / $6,046.39
| Facility | | $1,753.58 | $4,077.94 | $6,046.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.49 / $2,092.60 / $2,092.60
| Facility | | $146.49 | $2,092.60 | $2,092.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.06 / $731.00 / $1,936.96
| Facility | | $270.06 | $731.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |