- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.91 / $6,552.59 / $11,627.00
| Facility | | $532.91 | $6,552.59 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,528.00 / $14,996.00
| Facility | | $1,760.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.67 / $680.02 / $903.15
| Facility | | $566.67 | $680.02 | $903.15 |
- 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
- $2,840.00 / $5,998.00 / $7,853.00
| Facility | | $2,840.00 | $5,998.00 | $7,853.00 |