- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.33 / $5,780.60 / $10,148.24
| Facility | | $470.33 | $5,780.60 | $10,148.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.29 / $5,507.61 / $9,227.19
| Facility | | $2,054.29 | $5,507.61 | $9,227.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $2,106.17 / $2,706.47
| Facility | | $375.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.00 / $490.48 / $800.70
| Facility | | $365.00 | $490.48 | $800.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |