- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.14 / $5,621.00 / $9,870.00
| Facility | | $297.14 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.33 / $5,907.15 / $9,923.85
| Facility | | $2,285.33 | $5,907.15 | $9,923.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $2,048.92 / $2,632.90
| Facility | | $505.00 | $2,048.92 | $2,632.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.04 / $393.02 / $591.66
| Facility | | $269.04 | $393.02 | $591.66 |
- 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 |