- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.96 / $5,866.00 / $16,467.00
| Facility | | $371.96 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,282.81 / $10,261.71 / $17,182.04
| Facility | | $4,282.81 | $10,261.71 | $17,182.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.25 / $505.00 / $24,021.87
| Facility | | $355.25 | $505.00 | $24,021.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.02 / $364.25 / $680.44
| Facility | | $256.02 | $364.25 | $680.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $17,367.00 / $23,485.00
| Facility | | $2,912.00 | $17,367.00 | $23,485.00 |