- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.41 / $5,866.00 / $15,795.55
| Facility | | $490.41 | $5,866.00 | $15,795.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,531.55 / $6,184.58 / $10,605.01
| Facility | | $2,531.55 | $6,184.58 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.65 / $505.00 / $2,581.96
| Facility | | $490.65 | $505.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.53 / $573.62 / $913.57
| Facility | | $413.53 | $573.62 | $913.57 |
- 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 |