- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.00 / $2,318.00 / $7,212.00
| Facility | | $408.00 | $2,318.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,497.00 / $26,400.00 / $56,650.00
| Facility | | $3,497.00 | $26,400.00 | $56,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.27 / $515.15 / $594.41
| Facility | | $396.27 | $515.15 | $594.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,577.74 / $14,577.74 / $17,280.48
| Facility | | $14,577.74 | $14,577.74 | $17,280.48 |
- 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 |