- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.10 / $4,785.02 / $9,727.00
| Facility | | $239.10 | $4,785.02 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,884.61 / $5,320.67 / $9,210.43
| Facility | | $1,884.61 | $5,320.67 | $9,210.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,007.90 / $1,295.17
| Facility | | $505.00 | $1,007.90 | $1,295.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.67 / $298.88 / $472.63
| Facility | | $196.67 | $298.88 | $472.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,607.00 / $8,667.00
| Facility | | $659.00 | $6,607.00 | $8,667.00 |