- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.46 / $5,863.38 / $11,627.00
| Facility | | $824.46 | $5,863.38 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,528.00 / $14,996.00
| Facility | | $1,760.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.31 / $1,051.31 / $1,051.31
| Facility | | $1,051.31 | $1,051.31 | $1,051.31 |
- 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
- $2,840.00 / $5,920.00 / $7,847.00
| Facility | | $2,840.00 | $5,920.00 | $7,847.00 |