- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.79 / $5,467.00 / $12,237.00
| Facility | | $626.79 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $3,082.87 / $5,128.54
| Facility | | $2,312.00 | $3,082.87 | $5,128.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,517.00 / $12,517.00 / $12,517.00
| Facility | | $12,517.00 | $12,517.00 | $12,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.07 / $654.97 / $5,565.00
| Facility | | $416.07 | $654.97 | $5,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |