- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.16 / $1,818.82 / $10,453.00
| Facility | | $422.16 | $1,818.82 | $10,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,727.17 / $2,727.17 / $2,766.96
| Facility | | $2,727.17 | $2,727.17 | $2,766.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.16 / $1,818.82 / $2,352.80
| Facility | | $422.16 | $1,818.82 | $2,352.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,526.00
| Facility | | $2,248.00 | $9,541.00 | $14,526.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,195.44 / $3,195.44
| Facility | | $55.00 | $3,195.44 | $3,195.44 |