- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.62 / $4,375.00 / $16,467.00
| Facility | | $834.62 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.02 / $2,405.69 / $3,831.65
| Facility | | $1,063.02 | $2,405.69 | $3,831.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.32 / $830.32 / $890.00
| Facility | | $830.32 | $830.32 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.34 / $1,001.54 / $1,634.96
| Facility | | $762.34 | $1,001.54 | $1,634.96 |
- 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 |