- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.07 / $7,799.00 / $16,467.00
| Facility | | $701.07 | $7,799.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,355.47 / $10,202.45
| Facility | | $1,500.00 | $5,355.47 | $10,202.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $810.00 / $2,221.46
| Facility | | $375.00 | $810.00 | $2,221.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.72 / $701.07 / $1,191.82
| Facility | | $587.72 | $701.07 | $1,191.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $12,269.00 / $19,591.00
| Facility | | $870.00 | $12,269.00 | $19,591.00 |