- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.65 / $7,799.00 / $16,639.00
| Facility | | $373.65 | $7,799.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.80 / $5,895.33 / $10,114.27
| Facility | | $2,251.80 | $5,895.33 | $10,114.27 |
- 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
- $317.60 / $443.00 / $680.98
| Facility | | $317.60 | $443.00 | $680.98 |
- 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 |