- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.63 / $2,547.00 / $10,635.00
| Facility | | $908.63 | $2,547.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.00 / $3,554.00 / $19,117.00
| Facility | | $1,861.00 | $3,554.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.60 / $696.72 / $862.35
| Facility | | $580.60 | $696.72 | $862.35 |
- 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 / $5,998.00 / $7,847.00
| Facility | | $2,840.00 | $5,998.00 | $7,847.00 |