- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.70 / $4,375.00 / $16,467.00
| Facility | | $564.70 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,367.22 / $10,605.01
| Facility | | $2,866.56 | $6,367.22 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.54 / $890.00 / $2,581.96
| Facility | | $566.54 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.75 / $629.00 / $1,063.04
| Facility | | $506.75 | $629.00 | $1,063.04 |
- 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 |