- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.73 / $4,846.00 / $14,063.00
| Facility | | $806.73 | $4,846.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $9,015.00 / $20,600.00
| Facility | | $4,146.00 | $9,015.00 | $20,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.43 / $1,178.01 / $1,767.02
| Facility | | $834.43 | $1,178.01 | $1,767.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,833.32 / $3,833.32 / $3,833.32
| Facility | | $3,833.32 | $3,833.32 | $3,833.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |