- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.03 / $7,799.00 / $17,247.00
| Facility | | $702.03 | $7,799.00 | $17,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,120.54 / $5,808.35 / $9,670.36
| Facility | | $3,120.54 | $5,808.35 | $9,670.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $1,130.00 / $1,677.54
| Facility | | $1,130.00 | $1,130.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.91 / $761.41 / $1,185.71
| Facility | | $565.91 | $761.41 | $1,185.71 |
- 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 |