- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.34 / $1,387.26 / $9,727.00
| Facility | | $211.34 | $1,387.26 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.35 / $3,187.97 / $5,569.60
| Facility | | $1,198.35 | $3,187.97 | $5,569.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.75 / $1,244.75 / $1,599.53
| Facility | | $1,244.75 | $1,244.75 | $1,599.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.34 / $606.79 / $941.36
| Facility | | $211.34 | $606.79 | $941.36 |
- 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 |