- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.97 / $1,958.00 / $5,607.00
| Facility | | $619.97 | $1,958.00 | $5,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,881.93 / $9,492.32 / $18,913.21
| Facility | | $4,881.93 | $9,492.32 | $18,913.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.85 / $4,418.84 / $4,418.84
| Facility | | $362.85 | $4,418.84 | $4,418.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $711.69 / $5,708.01
| Facility | | $488.00 | $711.69 | $5,708.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $5,780.00 / $12,805.00
| Facility | | $1,100.00 | $5,780.00 | $12,805.00 |