- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.23 / $3,500.00 / $11,093.00
| Facility | | $995.23 | $3,500.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,705.10 / $16,700.00 / $33,821.32
| Facility | | $2,705.10 | $16,700.00 | $33,821.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.95 / $1,364.24 / $2,046.36
| Facility | | $993.95 | $1,364.24 | $2,046.36 |
- 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
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |