- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.51 / $3,158.00 / $10,439.00
| Facility | | $627.51 | $3,158.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.30 / $2,343.59 / $3,111.94
| Facility | | $1,141.30 | $2,343.59 | $3,111.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $8,996.00 / $8,996.00
| Facility | | $330.00 | $8,996.00 | $8,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.52 / $603.40 / $6,307.00
| Facility | | $373.52 | $603.40 | $6,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,946.00 / $6,988.00
| Facility | | $1,779.00 | $3,946.00 | $6,988.00 |