- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.90 / $4,751.00 / $16,467.00
| Facility | | $180.90 | $4,751.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $4,855.42 / $9,565.53
| Facility | | $2,187.00 | $4,855.42 | $9,565.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,106.17 / $2,706.47
| Facility | | $2,106.17 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.65 / $208.54 / $333.24
| Facility | | $152.65 | $208.54 | $333.24 |
- 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 |