- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.07 / $5,621.00 / $9,870.00
| Facility | | $295.07 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.25 / $4,795.45 / $9,578.29
| Facility | | $2,117.25 | $4,795.45 | $9,578.29 |
- 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
- $237.71 / $332.12 / $539.15
| Facility | | $237.71 | $332.12 | $539.15 |
- 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 |