- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.65 / $7,799.00 / $28,882.28
| Facility | | $646.65 | $7,799.00 | $28,882.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.48 / $4,996.76 / $8,927.19
| Facility | | $2,063.48 | $4,996.76 | $8,927.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,529.27 / $1,965.14
| Facility | | $715.00 | $1,529.27 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.75 / $631.01 / $1,238.41
| Facility | | $506.75 | $631.01 | $1,238.41 |
- 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 |