- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.64 / $2,970.10 / $16,467.00
| Facility | | $459.64 | $2,970.10 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.87 / $5,154.55 / $8,705.65
| Facility | | $2,453.87 | $5,154.55 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.89 / $890.00 / $2,581.96
| Facility | | $453.89 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.48 / $562.88 / $890.69
| Facility | | $451.48 | $562.88 | $890.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $9,904.00 / $16,249.00
| Facility | | $1,550.00 | $9,904.00 | $16,249.00 |