- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.19 / $5,135.00 / $11,627.00
| Facility | | $881.19 | $5,135.00 | $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
- $842.87 / $1,011.44 / $1,251.88
| Facility | | $842.87 | $1,011.44 | $1,251.88 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |