- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.85 / $9,300.29 / $16,467.00
| Facility | | $726.85 | $9,300.29 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,304.45 / $10,605.01
| Facility | | $2,866.56 | $6,304.45 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.93 / $1,100.00 / $2,581.96
| Facility | | $716.93 | $1,100.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.00 / $772.17 / $1,405.05
| Facility | | $590.00 | $772.17 | $1,405.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |