- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.22 / $1,300.00 / $3,025.91
| Facility | | $732.22 | $1,300.00 | $3,025.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,722.00 / $7,755.10 / $13,314.43
| Facility | | $2,722.00 | $7,755.10 | $13,314.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.00 / $1,083.75 / $1,287.72
| Facility | | $867.00 | $1,083.75 | $1,287.72 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |