- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $4,723.00 / $11,627.00
| Facility | | $204.17 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.99 / $1,831.00 / $3,840.45
| Facility | | $870.99 | $1,831.00 | $3,840.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.78 / $177.78 / $258.87
| Facility | | $177.78 | $177.78 | $258.87 |
- 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 |