- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.94 / $9,062.00 / $30,829.00
| Facility | | $292.94 | $9,062.00 | $30,829.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.34 / $5,378.35 / $9,678.37
| Facility | | $1,996.34 | $5,378.35 | $9,678.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $2,486.00 / $3,194.56
| Facility | | $2,486.00 | $2,486.00 | $3,194.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.06 / $341.99 / $503.73
| Facility | | $226.06 | $341.99 | $503.73 |
- 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 |