- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.07 / $1,057.83 / $9,727.00
| Facility | | $381.07 | $1,057.83 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.80 / $5,908.67 / $10,140.68
| Facility | | $2,251.80 | $5,908.67 | $10,140.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $3,208.42 / $4,122.88
| Facility | | $375.00 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.86 / $553.74 / $1,156.00
| Facility | | $359.86 | $553.74 | $1,156.00 |
- 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 |