- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.39 / $8,876.00 / $16,961.64
| Facility | | $776.39 | $8,876.00 | $16,961.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,866.56 / $6,304.45 / $10,605.01
| Facility | | $2,866.56 | $6,304.45 | $10,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $770.39 / $7,478.70
| Facility | | $580.00 | $770.39 | $7,478.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.96 / $872.05 / $1,421.44
| Facility | | $669.96 | $872.05 | $1,421.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,878.00 / $16,901.00
| Facility | | $1,550.00 | $10,878.00 | $16,901.00 |