- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.84 / $4,375.00 / $16,467.00
| Facility | | $593.84 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.02 / $4,069.15 / $6,619.00
| Facility | | $2,153.02 | $4,069.15 | $6,619.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $1,985.43
| Facility | | $375.00 | $375.00 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.00 / $593.84 / $836.78
| Facility | | $453.00 | $593.84 | $836.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |