- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.02 / $5,866.00 / $16,467.00
| Facility | | $321.02 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.32 / $3,392.97 / $5,873.68
| Facility | | $1,307.32 | $3,392.97 | $5,873.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.42 / $780.00 / $1,512.28
| Facility | | $318.42 | $780.00 | $1,512.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.66 / $429.67 / $590.59
| Facility | | $314.66 | $429.67 | $590.59 |
- 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 |