- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.22 / $9,040.00 / $12,672.00
| Facility | | $656.22 | $9,040.00 | $12,672.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $6,462.00 / $29,406.00
| Facility | | $1,895.00 | $6,462.00 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.22 / $354.22 / $515.79
| Facility | | $354.22 | $354.22 | $515.79 |
- 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 / $10,707.00 / $15,469.00
| Facility | | $4,873.00 | $10,707.00 | $15,469.00 |