- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.56 / $4,723.00 / $11,627.00
| Facility | | $162.56 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.62 / $3,355.45 / $6,387.06
| Facility | | $1,711.62 | $3,355.45 | $6,387.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.29 / $138.29 / $201.37
| Facility | | $138.29 | $138.29 | $201.37 |
- 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 |