- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.94 / $3,696.00 / $11,627.00
| Facility | | $822.94 | $3,696.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $7,949.51 / $14,996.00
| Facility | | $3,315.00 | $7,949.51 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.32 / $1,049.18 / $1,298.58
| Facility | | $874.32 | $1,049.18 | $1,298.58 |
- 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 |