- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.93 / $2,678.00 / $15,676.00
| Facility | | $794.93 | $2,678.00 | $15,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $2,867.00 / $3,728.00
| Facility | | $1,671.00 | $2,867.00 | $3,728.00 |
- 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
- $1,867.35 / $5,564.75 / $16,394.00
| Facility | | $1,867.35 | $5,564.75 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $2,297.00 / $4,099.00
| Facility | | $1,130.00 | $2,297.00 | $4,099.00 |