- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.61 / $3,265.00 / $12,565.00
| Facility | | $885.61 | $3,265.00 | $12,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,426.00 / $19,117.00
| Facility | | $2,084.00 | $4,426.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.49 / $1,009.79 / $1,249.83
| Facility | | $841.49 | $1,009.79 | $1,249.83 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |