- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.07 / $3,776.00 / $9,727.00
| Facility | | $775.07 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,327.91 / $11,405.05 / $20,652.61
| Facility | | $5,327.91 | $11,405.05 | $20,652.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $580.00 / $1,370.63
| Facility | | $375.00 | $580.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.07 / $1,064.00 / $1,832.95
| Facility | | $775.07 | $1,064.00 | $1,832.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |