- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.81 / $5,621.00 / $9,870.00
| Facility | | $391.81 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.94 / $5,908.67 / $10,140.68
| Facility | | $2,220.94 | $5,908.67 | $10,140.68 |
- 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
- $333.04 / $477.00 / $757.00
| Facility | | $333.04 | $477.00 | $757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.00 / $10,147.00 / $16,816.00
| Facility | | $2,764.00 | $10,147.00 | $16,816.00 |