- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.61 / $4,230.00 / $9,727.00
| Facility | | $278.61 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,204.60 / $5,713.28 / $9,961.21
| Facility | | $2,204.60 | $5,713.28 | $9,961.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,554.41 / $2,554.41 / $3,282.46
| Facility | | $2,554.41 | $2,554.41 | $3,282.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.59 / $537.88 / $923.00
| Facility | | $245.59 | $537.88 | $923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $13,680.00 / $20,474.00
| Facility | | $2,155.00 | $13,680.00 | $20,474.00 |