- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.53 / $2,232.12 / $11,093.00
| Facility | | $868.53 | $2,232.12 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,935.00 / $12,775.00 / $30,091.00
| Facility | | $1,935.00 | $12,775.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.20 / $1,096.33 / $1,265.00
| Facility | | $860.20 | $1,096.33 | $1,265.00 |
- 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 |