- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.59 / $5,371.73 / $9,870.00
| Facility | | $441.59 | $5,371.73 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.77 / $6,836.09 / $11,947.84
| Facility | | $2,764.77 | $6,836.09 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.77 / $505.00 / $1,370.63
| Facility | | $443.77 | $505.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.54 / $546.85 / $834.26
| Facility | | $424.54 | $546.85 | $834.26 |
- 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 |