- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.46 / $5,192.00 / $9,870.00
| Facility | | $691.46 | $5,192.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.29 / $5,391.80 / $9,227.19
| Facility | | $2,054.29 | $5,391.80 | $9,227.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,106.17 / $2,706.47
| Facility | | $2,106.17 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.47 / $718.83 / $1,190.38
| Facility | | $545.47 | $718.83 | $1,190.38 |
- 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 |