- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.72 / $2,838.15 / $8,876.00
| Facility | | $311.72 | $2,838.15 | $8,876.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.44 / $4,350.31 / $7,881.56
| Facility | | $1,864.44 | $4,350.31 | $7,881.56 |
- 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
- $197.30 / $285.00 / $473.55
| Facility | | $197.30 | $285.00 | $473.55 |
- 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 |