- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.73 / $5,217.00 / $11,627.00
| Facility | | $861.73 | $5,217.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.72 / $662.06 / $1,034.48
| Facility | | $551.72 | $662.06 | $1,034.48 |
- 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 |