- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.02 / $4,723.00 / $11,627.00
| Facility | | $935.02 | $4,723.00 | $11,627.00 |
- 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
- $887.10 / $1,064.52 / $1,317.58
| Facility | | $887.10 | $1,064.52 | $1,317.58 |
- 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
- $2,647.00 / $4,410.00 / $7,427.00
| Facility | | $2,647.00 | $4,410.00 | $7,427.00 |