- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.66 / $2,547.00 / $10,268.00
| Facility | | $753.66 | $2,547.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.00 / $2,792.00 / $8,800.00
| Facility | | $1,191.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.75 / $561.29 / $694.74
| Facility | | $467.75 | $561.29 | $694.74 |
- 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
- $2,549.42 / $3,724.00 / $6,238.00
| Facility | | $2,549.42 | $3,724.00 | $6,238.00 |