- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.61 / $3,586.62 / $16,467.00
| Facility | | $254.61 | $3,586.62 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.79 / $5,322.39 / $9,210.43
| Facility | | $1,910.79 | $5,322.39 | $9,210.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,048.92 / $2,632.90
| Facility | | $580.00 | $2,048.92 | $2,632.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.40 / $328.40 / $507.75
| Facility | | $215.40 | $328.40 | $507.75 |
- 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 |