- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.57 / $4,230.00 / $9,727.00
| Facility | | $243.57 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,339.08 / $5,867.32 / $10,114.27
| Facility | | $2,339.08 | $5,867.32 | $10,114.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,221.33 / $1,569.43
| Facility | | $505.00 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.57 / $377.00 / $623.49
| Facility | | $243.57 | $377.00 | $623.49 |
- 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 |