- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.93 / $2,867.51 / $9,727.00
| Facility | | $262.93 | $2,867.51 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.25 / $4,822.34 / $9,582.91
| Facility | | $2,117.25 | $4,822.34 | $9,582.91 |
- 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
- $262.93 / $1,215.65 / $1,972.08
| Facility | | $262.93 | $1,215.65 | $1,972.08 |
- 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 |