- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.87 / $8,960.00 / $14,644.00
| Facility | | $297.87 | $8,960.00 | $14,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.94 / $5,853.24 / $10,114.27
| Facility | | $2,220.94 | $5,853.24 | $10,114.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $2,106.17 / $2,706.47
| Facility | | $815.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.33 / $335.48 / $586.85
| Facility | | $240.33 | $335.48 | $586.85 |
- 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 |