- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.16 / $5,621.00 / $9,870.00
| Facility | | $321.16 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.34 / $4,588.63 / $8,041.18
| Facility | | $1,794.34 | $4,588.63 | $8,041.18 |
- 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
- $257.37 / $354.28 / $578.04
| Facility | | $257.37 | $354.28 | $578.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,069.00 / $16,249.00
| Facility | | $1,981.00 | $10,069.00 | $16,249.00 |