- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $4,951.89 / $11,474.00
| Facility | | $900.00 | $4,951.89 | $11,474.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,830.85 / $13,598.58 / $21,258.76
| Facility | | $11,830.85 | $13,598.58 | $21,258.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,920.00 / $7,920.00
| Facility | | $2,960.00 | $7,920.00 | $7,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,733.37 / $10,609.60 / $16,699.18
| Facility | | $8,733.37 | $10,609.60 | $16,699.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.00 / $6,574.00 / $13,917.56
| Facility | | $2,334.00 | $6,574.00 | $13,917.56 |