- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.26 / $3,508.40 / $9,062.00
| Facility | | $273.26 | $3,508.40 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.48 / $5,008.77 / $8,927.19
| Facility | | $2,063.48 | $5,008.77 | $8,927.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,529.27 / $1,965.14
| Facility | | $375.00 | $1,529.27 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.27 / $353.43 / $529.11
| Facility | | $232.27 | $353.43 | $529.11 |
- 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 |