- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.47 / $4,230.00 / $9,727.00
| Facility | | $195.47 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.92 / $4,418.18 / $7,616.08
| Facility | | $2,175.92 | $4,418.18 | $7,616.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.54 / $1,677.54 / $1,677.54
| Facility | | $1,677.54 | $1,677.54 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.31 / $719.85 / $1,212.20
| Facility | | $179.31 | $719.85 | $1,212.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,147.00 / $16,816.00
| Facility | | $1,981.00 | $10,147.00 | $16,816.00 |