- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.30 / $1,460.17 / $16,467.00
| Facility | | $394.30 | $1,460.17 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.81 / $5,095.07 / $8,656.54
| Facility | | $2,435.81 | $5,095.07 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $591.32 / $5,740.31
| Facility | | $580.00 | $591.32 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.71 / $596.29 / $974.75
| Facility | | $396.71 | $596.29 | $974.75 |
- 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 |