- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.54 / $4,375.00 / $16,467.00
| Facility | | $128.54 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,483.92 / $4,694.54 / $7,666.70
| Facility | | $2,483.92 | $4,694.54 | $7,666.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $1,677.54
| Facility | | $375.00 | $375.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.00 / $128.54 / $215.00
| Facility | | $98.00 | $128.54 | $215.00 |
- 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 |