- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.80 / $5,866.00 / $9,062.00
| Facility | | $627.80 | $5,866.00 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.07 / $4,724.71 / $8,473.82
| Facility | | $2,237.07 | $4,724.71 | $8,473.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $624.92 / $1,965.14
| Facility | | $505.00 | $624.92 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.46 / $668.00 / $1,194.95
| Facility | | $558.46 | $668.00 | $1,194.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |