- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.67 / $4,375.00 / $16,467.00
| Facility | | $973.67 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.98 / $4,694.54 / $7,666.70
| Facility | | $2,258.98 | $4,694.54 | $7,666.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $2,594.85
| Facility | | $375.00 | $375.00 | $2,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.00 / $811.00 / $1,255.76
| Facility | | $592.00 | $811.00 | $1,255.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $13,190.00 / $19,665.00
| Facility | | $2,155.00 | $13,190.00 | $19,665.00 |