- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.06 / $2,472.00 / $17,225.00
| Facility | | $947.06 | $2,472.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.00 / $11,294.00 / $22,813.00
| Facility | | $3,719.00 | $11,294.00 | $22,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.08 / $1,184.40 / $1,366.62
| Facility | | $911.08 | $1,184.40 | $1,366.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,538.02 / $5,538.02 / $6,564.78
| Facility | | $5,538.02 | $5,538.02 | $6,564.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |