- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.31 / $7,799.00 / $16,467.00
| Facility | | $935.31 | $7,799.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.42 / $5,210.14 / $8,760.50
| Facility | | $2,430.42 | $5,210.14 | $8,760.50 |
- 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
- $766.10 / $961.12 / $1,590.03
| Facility | | $766.10 | $961.12 | $1,590.03 |
- 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 |