- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.62 / $1,816.22 / $16,467.00
| Facility | | $762.62 | $1,816.22 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.82 / $27,416.96 / $43,667.88
| Facility | | $12,114.82 | $27,416.96 | $43,667.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.80 / $760.80 / $890.00
| Facility | | $760.80 | $760.80 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.62 / $953.27 / $1,498.46
| Facility | | $762.62 | $953.27 | $1,498.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $19,915.00 / $30,476.00
| Facility | | $3,340.00 | $19,915.00 | $30,476.00 |