- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.42 / $2,095.00 / $7,838.38
| Facility | | $890.42 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,965.91 / $13,992.02 / $21,712.27
| Facility | | $3,965.91 | $13,992.02 | $21,712.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $3,800.00
| Facility | | $3,800.00 | $3,800.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.03 / $1,025.94 / $3,464.13
| Facility | | $804.03 | $1,025.94 | $3,464.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $8,842.00 / $16,897.00
| Facility | | $899.00 | $8,842.00 | $16,897.00 |