- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.95 / $1,392.30 / $16,467.00
| Facility | | $621.95 | $1,392.30 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.00 / $4,583.06 / $7,916.70
| Facility | | $1,888.00 | $4,583.06 | $7,916.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,106.17 / $2,706.47
| Facility | | $2,106.17 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.48 / $684.15 / $1,121.76
| Facility | | $499.48 | $684.15 | $1,121.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |