- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.20 / $1,628.00 / $17,225.00
| Facility | | $672.20 | $1,628.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,581.00 / $8,240.00 / $17,829.00
| Facility | | $3,581.00 | $8,240.00 | $17,829.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.02 / $842.43 / $972.03
| Facility | | $648.02 | $842.43 | $972.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.80 / $1,868.80 / $2,215.28
| Facility | | $1,868.80 | $1,868.80 | $2,215.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.00 / $6,032.00 / $10,413.00
| Facility | | $3,138.00 | $6,032.00 | $10,413.00 |