- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.11 / $3,889.82 / $11,093.00
| Facility | | $851.11 | $3,889.82 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,940.32 / $14,400.00 / $33,555.00
| Facility | | $2,940.32 | $14,400.00 | $33,555.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.09 / $1,077.82 / $1,624.58
| Facility | | $829.09 | $1,077.82 | $1,624.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,330.00 / $17,416.00
| Facility | | $5,431.00 | $12,330.00 | $17,416.00 |