- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.11 / $4,107.93 / $9,062.00
| Facility | | $707.11 | $4,107.93 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.26 / $5,635.94 / $9,856.10
| Facility | | $1,654.26 | $5,635.94 | $9,856.10 |
- 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
- $263.51 / $396.00 / $611.85
| Facility | | $263.51 | $396.00 | $611.85 |
- 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 |