- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.56 / $1,199.63 / $16,467.00
| Facility | | $504.56 | $1,199.63 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.00 / $5,580.52 / $9,996.04
| Facility | | $1,680.00 | $5,580.52 | $9,996.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $9,393.19
| Facility | | $375.00 | $615.00 | $9,393.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.88 / $591.28 / $863.50
| Facility | | $428.88 | $591.28 | $863.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $12,269.00 / $19,591.00
| Facility | | $870.00 | $12,269.00 | $19,591.00 |