- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.32 / $7,783.57 / $10,639.00
| Facility | | $663.32 | $7,783.57 | $10,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,409.76 / $9,130.29
| Facility | | $1,061.00 | $4,409.76 | $9,130.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $715.56 / $1,842.86
| Facility | | $375.00 | $715.56 | $1,842.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.26 / $586.66 / $1,008.00
| Facility | | $434.26 | $586.66 | $1,008.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,147.00 / $16,772.00
| Facility | | $791.00 | $10,147.00 | $16,772.00 |