- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.43 / $5,192.00 / $20,704.30
| Facility | | $339.43 | $5,192.00 | $20,704.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,083.96 / $5,853.24 / $10,114.27
| Facility | | $2,083.96 | $5,853.24 | $10,114.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $2,106.17 / $2,706.47
| Facility | | $505.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.77 / $382.89 / $616.92
| Facility | | $275.77 | $382.89 | $616.92 |
- 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 |