- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.62 / $2,472.00 / $17,225.00
| Facility | | $885.62 | $2,472.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,526.00 / $14,542.00 / $37,919.46
| Facility | | $3,526.00 | $14,542.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.41 / $1,207.04 / $1,810.56
| Facility | | $879.41 | $1,207.04 | $1,810.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,645.51 / $11,645.51 / $13,804.61
| Facility | | $11,645.51 | $11,645.51 | $13,804.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,649.00
| Facility | | $5,058.00 | $12,330.00 | $17,649.00 |