- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.84 / $2,675.00 / $10,768.00
| Facility | | $994.84 | $2,675.00 | $10,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,637.23
| Facility | | $606.10 | $606.10 | $7,637.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.84 / $1,263.25 / $1,947.13
| Facility | | $994.84 | $1,263.25 | $1,947.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,723.76 / $25,239.65 / $26,542.00
| Facility | | $3,723.76 | $25,239.65 | $26,542.00 |