- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.72 / $4,862.00 / $17,521.64
| Facility | | $364.72 | $4,862.00 | $17,521.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.32 / $4,454.43 / $7,943.74
| Facility | | $1,744.32 | $4,454.43 | $7,943.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $2,130.29 / $2,737.46
| Facility | | $375.00 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.81 / $396.25 / $676.41
| Facility | | $310.81 | $396.25 | $676.41 |
- 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 |