- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.85 / $5,706.00 / $11,627.00
| Facility | | $597.85 | $5,706.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $13,163.00 / $36,529.00
| Facility | | $2,097.00 | $13,163.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.13 / $321.13 / $467.60
| Facility | | $321.13 | $321.13 | $467.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $11,553.00 / $30,266.00
| Facility | | $4,873.00 | $11,553.00 | $30,266.00 |