- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.60 / $5,866.00 / $16,467.00
| Facility | | $422.60 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,441.81 / $5,267.76 / $8,842.83
| Facility | | $2,441.81 | $5,267.76 | $8,842.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.52 / $505.00 / $1,965.14
| Facility | | $428.52 | $505.00 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.77 / $521.07 / $785.44
| Facility | | $398.77 | $521.07 | $785.44 |
- 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 |