- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.71 / $3,038.13 / $11,674.00
| Facility | | $472.71 | $3,038.13 | $11,674.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.51 / $4,409.76 / $9,143.61
| Facility | | $1,469.51 | $4,409.76 | $9,143.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $680.12 / $1,842.86
| Facility | | $375.00 | $680.12 | $1,842.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.06 / $543.62 / $956.07
| Facility | | $377.06 | $543.62 | $956.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |