- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.08 / $6,343.00 / $10,492.00
| Facility | | $156.08 | $6,343.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,835.00 / $14,346.65 / $20,248.00
| Facility | | $10,835.00 | $14,346.65 | $20,248.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $998.00 / $998.00
| Facility | | $998.00 | $998.00 | $998.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.16 / $809.30 / $1,060.24
| Facility | | $556.16 | $809.30 | $1,060.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.00 / $3,134.00 / $6,664.00
| Facility | | $357.00 | $3,134.00 | $6,664.00 |