- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.00 / $3,940.00 / $15,676.00
| Facility | | $853.00 | $3,940.00 | $15,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,611.00 / $5,774.00
| Facility | | $2,132.00 | $3,611.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,483.00 / $26,483.00 / $26,483.00
| Facility | | $26,483.00 | $26,483.00 | $26,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.20 / $11,082.10 / $11,933.00
| Facility | | $1,779.20 | $11,082.10 | $11,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,567.00 / $7,604.00
| Facility | | $2,426.00 | $4,567.00 | $7,604.00 |