- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.91 / $4,723.00 / $11,627.00
| Facility | | $802.91 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,010.00 / $36,529.00
| Facility | | $2,097.00 | $8,010.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.77 / $699.77 / $1,018.96
| Facility | | $699.77 | $699.77 | $1,018.96 |
- 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 |