- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $8,912.51
| Facility | | $100.00 | $100.00 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $3,235.94 / $4,897.79
| Facility | | $25.12 | $3,235.94 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,943.28 / $9,772.37
| Facility | | $2,290.87 | $7,943.28 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $12,302.69
| Facility | | $3,467.37 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $524.81 / $741.31
| Facility | | $446.68 | $524.81 | $741.31 |