- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.69 / $2,884.35 / $9,062.00
| Facility | | $190.69 | $2,884.35 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.09 / $5,390.43 / $9,227.19
| Facility | | $1,612.09 | $5,390.43 | $9,227.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.33 / $1,221.33 / $1,569.43
| Facility | | $1,221.33 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $197.23 / $349.66
| Facility | | $108.00 | $197.23 | $349.66 |
- 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 |