- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.22 / $1,376.28 / $9,727.00
| Facility | | $504.22 | $1,376.28 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,942.30 / $4,437.85 / $9,252.18
| Facility | | $1,942.30 | $4,437.85 | $9,252.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,774.26 / $2,279.96
| Facility | | $375.00 | $1,774.26 | $2,279.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.89 / $623.00 / $1,012.06
| Facility | | $464.89 | $623.00 | $1,012.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |