- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.27 / $8,872.00 / $11,627.00
| Facility | | $341.27 | $8,872.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,907.98 / $3,969.26 / $7,416.07
| Facility | | $1,907.98 | $3,969.26 | $7,416.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.46 / $199.46 / $290.44
| Facility | | $199.46 | $199.46 | $290.44 |
- 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 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |