- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.90 / $2,087.92 / $10,924.00
| Facility | | $119.90 | $2,087.92 | $10,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,989.37 / $2,989.37 / $2,989.37
| Facility | | $2,989.37 | $2,989.37 | $2,989.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.28 / $957.19 / $2,192.27
| Facility | | $70.28 | $957.19 | $2,192.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,693.00 / $11,645.00 / $19,066.00
| Facility | | $1,693.00 | $11,645.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.90 / $2,381.90 / $11,500.00
| Facility | | $2,381.90 | $2,381.90 | $11,500.00 |