- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.57 / $5,866.00 / $16,467.00
| Facility | | $454.57 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.39 / $5,205.85 / $8,724.34
| Facility | | $2,347.39 | $5,205.85 | $8,724.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.88 / $505.00 / $1,370.63
| Facility | | $444.88 | $505.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.56 / $545.48 / $890.69
| Facility | | $399.56 | $545.48 | $890.69 |
- 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 |