- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.20 / $3,660.00 / $10,268.00
| Facility | | $929.20 | $3,660.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.00 / $5,129.00 / $25,522.00
| Facility | | $2,082.00 | $5,129.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.41 / $761.30 / $942.29
| Facility | | $634.41 | $761.30 | $942.29 |
- 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
- $4,070.00 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |