- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.93 / $2,936.00 / $10,268.00
| Facility | | $682.93 | $2,936.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,405.00 / $14,996.00
| Facility | | $1,760.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.95 / $535.14 / $836.16
| Facility | | $445.95 | $535.14 | $836.16 |
- 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
- $2,466.00 / $4,404.00 / $6,831.00
| Facility | | $2,466.00 | $4,404.00 | $6,831.00 |