- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.02 / $12,235.00 / $23,598.00
| Facility | | $684.02 | $12,235.00 | $23,598.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,344.06 / $12,593.29 / $29,597.17
| Facility | | $12,344.06 | $12,593.29 | $29,597.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,940.24 / $12,940.24 / $16,628.45
| Facility | | $12,940.24 | $12,940.24 | $16,628.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.55 / $825.55 / $1,341.27
| Facility | | $587.55 | $825.55 | $1,341.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |