- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.26 / $4,104.14 / $9,863.00
| Facility | | $473.26 | $4,104.14 | $9,863.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,002.93 / $5,049.96 / $8,780.07
| Facility | | $2,002.93 | $5,049.96 | $8,780.07 |
- 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
- $268.37 / $422.81 / $724.05
| Facility | | $268.37 | $422.81 | $724.05 |
- 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 |