- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.55 / $4,723.00 / $11,627.00
| Facility | | $917.55 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,786.00 / $8,800.00
| Facility | | $1,145.00 | $2,786.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.32 / $797.32 / $1,161.00
| Facility | | $797.32 | $797.32 | $1,161.00 |
- 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 |