- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.80 / $6,273.05 / $13,657.33
| Facility | | $964.80 | $6,273.05 | $13,657.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,026.15 / $5,247.83 / $9,226.56
| Facility | | $2,026.15 | $5,247.83 | $9,226.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $2,106.17 / $2,706.47
| Facility | | $715.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.27 / $477.60 / $775.54
| Facility | | $358.27 | $477.60 | $775.54 |
- 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 |