- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.18 / $5,730.21 / $15,723.00
| Facility | | $392.18 | $5,730.21 | $15,723.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,922.55 / $11,164.91 / $18,360.62
| Facility | | $5,922.55 | $11,164.91 | $18,360.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.96 / $890.00 / $8,029.95
| Facility | | $583.96 | $890.00 | $8,029.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.18 / $5,730.21 / $10,669.15
| Facility | | $392.18 | $5,730.21 | $10,669.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |