- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.70 / $4,450.00 / $8,031.00
| Facility | | $982.70 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,508.27 / $28,833.26 / $37,069.00
| Facility | | $24,508.27 | $28,833.26 | $37,069.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,302.00 / $4,390.00 / $4,645.51
| Facility | | $4,302.00 | $4,390.00 | $4,645.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,325.00 / $7,843.00 / $11,371.00
| Facility | | $5,325.00 | $7,843.00 | $11,371.00 |