- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.16 / $5,621.00 / $9,870.00
| Facility | | $193.16 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,768.56 / $4,471.00 / $7,943.74
| Facility | | $1,768.56 | $4,471.00 | $7,943.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.29 / $2,130.29 / $2,737.46
| Facility | | $2,130.29 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.99 / $203.17 / $358.40
| Facility | | $161.99 | $203.17 | $358.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,918.00 / $16,772.00
| Facility | | $1,981.00 | $10,918.00 | $16,772.00 |