- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.39 / $8,783.00 / $16,639.00
| Facility | | $400.39 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.39 / $5,154.55 / $8,705.65
| Facility | | $2,347.39 | $5,154.55 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.63 / $580.00 / $1,370.63
| Facility | | $400.63 | $580.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.00 / $484.47 / $748.84
| Facility | | $386.00 | $484.47 | $748.84 |
- 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 |