- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.20 / $2,936.89 / $9,727.00
| Facility | | $307.20 | $2,936.89 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.94 / $5,908.67 / $10,140.68
| Facility | | $2,220.94 | $5,908.67 | $10,140.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.33 / $1,221.33 / $1,569.43
| Facility | | $1,221.33 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.20 / $1,220.41 / $2,165.21
| Facility | | $307.20 | $1,220.41 | $2,165.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |