- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.31 / $1,910.27 / $16,467.00
| Facility | | $792.31 | $1,910.27 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,401.93 / $21,277.44 / $33,889.28
| Facility | | $9,401.93 | $21,277.44 | $33,889.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.25 / $787.25 / $890.00
| Facility | | $787.25 | $787.25 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.31 / $1,004.52 / $1,564.03
| Facility | | $792.31 | $1,004.52 | $1,564.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |