- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.88 / $5,457.85 / $11,627.00
| Facility | | $612.88 | $5,457.85 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.00 / $5,480.00 / $25,522.00
| Facility | | $2,202.00 | $5,480.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.33 / $383.21 / $508.95
| Facility | | $319.33 | $383.21 | $508.95 |
- 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
- $4,227.00 / $9,067.00 / $14,134.00
| Facility | | $4,227.00 | $9,067.00 | $14,134.00 |