- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.73 / $1,941.00 / $7,212.00
| Facility | | $620.73 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $20,600.00
| Facility | | $2,796.00 | $6,340.00 | $20,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.58 / $782.02 / $902.33
| Facility | | $613.58 | $782.02 | $902.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,833.32 / $3,833.32 / $3,833.32
| Facility | | $3,833.32 | $3,833.32 | $3,833.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |