- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.46 / $3,325.00 / $10,635.00
| Facility | | $809.46 | $3,325.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $2,894.00 / $8,800.00
| Facility | | $1,152.00 | $2,894.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.37 / $770.84 / $770.84
| Facility | | $529.37 | $770.84 | $770.84 |
- 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
- $2,233.00 / $4,138.00 / $6,522.00
| Facility | | $2,233.00 | $4,138.00 | $6,522.00 |