- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.04 / $4,723.00 / $11,627.00
| Facility | | $789.04 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $4,932.00 / $25,522.00
| Facility | | $2,291.00 | $4,932.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.57 / $909.08 / $1,125.19
| Facility | | $757.57 | $909.08 | $1,125.19 |
- 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
- $1,771.00 / $3,098.00 / $6,792.00
| Facility | | $1,771.00 | $3,098.00 | $6,792.00 |