- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.78 / $5,201.00 / $11,627.00
| Facility | | $760.78 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,275.00 / $8,403.62 / $17,308.66
| Facility | | $4,275.00 | $8,403.62 | $17,308.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.84 / $600.42 / $797.45
| Facility | | $467.84 | $600.42 | $797.45 |
- 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
- $600.91 / $600.91 / $600.91
| Facility | | $600.91 | $600.91 | $600.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |