- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.94 / $4,723.00 / $10,817.74
| Facility | | $996.94 | $4,723.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $7,880.43 / $14,996.00
| Facility | | $3,315.00 | $7,880.43 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.86 / $1,153.05 / $1,455.62
| Facility | | $791.86 | $1,153.05 | $1,455.62 |
- 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
- $1,480.00 / $3,086.00 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |