- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.96 / $8,960.00 / $16,467.00
| Facility | | $522.96 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.87 / $5,154.55 / $8,724.34
| Facility | | $2,453.87 | $5,154.55 | $8,724.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.03 / $815.00 / $2,581.96
| Facility | | $520.03 | $815.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.34 / $617.02 / $999.73
| Facility | | $498.34 | $617.02 | $999.73 |
- 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 |