- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.32 / $4,723.00 / $11,627.00
| Facility | | $777.32 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.00 / $8,916.52 / $16,045.41
| Facility | | $3,392.00 | $8,916.52 | $16,045.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.78 / $676.78 / $985.47
| Facility | | $676.78 | $676.78 | $985.47 |
- 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 |