- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.45 / $2,318.00 / $16,042.00
| Facility | | $809.45 | $2,318.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,239.00 / $12,289.00 / $37,919.46
| Facility | | $3,239.00 | $12,289.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.54 / $1,109.77 / $1,664.66
| Facility | | $808.54 | $1,109.77 | $1,664.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,571.11 / $11,571.11 / $13,716.41
| Facility | | $11,571.11 | $11,571.11 | $13,716.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |