- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.94 / $2,475.00 / $9,516.00
| Facility | | $652.94 | $2,475.00 | $9,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,541.00 / $14,996.00
| Facility | | $1,712.00 | $3,541.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.54 / $415.85 / $514.70
| Facility | | $346.54 | $415.85 | $514.70 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |