- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.72 / $1,494.00 / $10,985.00
| Facility | | $866.72 | $1,494.00 | $10,985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,044.00 / $11,021.00 / $30,091.00
| Facility | | $5,044.00 | $11,021.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.98 / $1,034.88 / $1,194.08
| Facility | | $811.98 | $1,034.88 | $1,194.08 |
- 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
- $4,889.57 / $10,855.00 / $17,380.00
| Facility | | $4,889.57 | $10,855.00 | $17,380.00 |