- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.93 / $9,062.00 / $18,276.00
| Facility | | $659.93 | $9,062.00 | $18,276.00 |
- 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
- $660.64 / $715.00 / $2,581.96
| Facility | | $660.64 | $715.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.17 / $677.58 / $1,253.66
| Facility | | $578.17 | $677.58 | $1,253.66 |
- 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 |