- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.93 / $9,062.00 / $16,467.00
| Facility | | $734.93 | $9,062.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,228.87 / $4,468.18 / $8,009.20
| Facility | | $2,228.87 | $4,468.18 | $8,009.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,130.29 / $2,737.46
| Facility | | $1,130.00 | $2,130.29 | $2,737.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.29 / $808.42 / $1,419.57
| Facility | | $626.29 | $808.42 | $1,419.57 |
- 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 |