- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.71 / $4,230.00 / $9,727.00
| Facility | | $430.71 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.52 / $5,008.77 / $8,927.19
| Facility | | $2,209.52 | $5,008.77 | $8,927.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $642.04 / $1,158.06
| Facility | | $505.00 | $642.04 | $1,158.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.56 / $560.69 / $920.02
| Facility | | $398.56 | $560.69 | $920.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |