- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.69 / $2,628.05 / $17,247.00
| Facility | | $255.69 | $2,628.05 | $17,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.00 / $7,621.64 / $13,640.30
| Facility | | $1,888.00 | $7,621.64 | $13,640.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.77 / $2,831.77 / $3,638.88
| Facility | | $2,831.77 | $2,831.77 | $3,638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.69 / $1,017.18 / $1,839.06
| Facility | | $255.69 | $1,017.18 | $1,839.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |