- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.39 / $5,621.00 / $9,870.00
| Facility | | $295.39 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,254.02 / $5,756.96 / $9,923.85
| Facility | | $2,254.02 | $5,756.96 | $9,923.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,086.58 / $3,086.58 / $3,966.31
| Facility | | $3,086.58 | $3,086.58 | $3,966.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.77 / $355.50 / $549.80
| Facility | | $266.77 | $355.50 | $549.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |