- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.64 / $4,723.00 / $11,627.00
| Facility | | $658.64 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,408.00 / $14,299.15 / $25,723.30
| Facility | | $4,408.00 | $14,299.15 | $25,723.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.92 / $755.92 / $1,181.11
| Facility | | $629.92 | $755.92 | $1,181.11 |
- 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
- $4,873.00 / $10,707.00 / $15,469.00
| Facility | | $4,873.00 | $10,707.00 | $15,469.00 |