- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.86 / $3,660.00 / $11,679.00
| Facility | | $709.86 | $3,660.00 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $18,482.00 / $60,320.00
| Facility | | $2,807.00 | $18,482.00 | $60,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.39 / $608.87 / $951.36
| Facility | | $507.39 | $608.87 | $951.36 |
- 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
- $5,778.00 / $18,167.00 / $31,222.00
| Facility | | $5,778.00 | $18,167.00 | $31,222.00 |