- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.27 / $5,621.00 / $9,870.00
| Facility | | $235.27 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,375.34 / $4,077.63
| Facility | | $1,000.00 | $2,375.34 | $4,077.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,048.92 / $2,048.92 / $2,632.90
| Facility | | $2,048.92 | $2,048.92 | $2,632.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.73 / $308.31 / $442.30
| Facility | | $205.73 | $308.31 | $442.30 |
- 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 |