- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.21 / $4,723.00 / $11,627.00
| Facility | | $803.21 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $2,792.00 / $8,800.00
| Facility | | $1,152.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.18 / $1,017.18 / $1,284.08
| Facility | | $1,017.18 | $1,017.18 | $1,284.08 |
- 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
- $1,020.00 / $1,940.00 / $4,132.00
| Facility | | $1,020.00 | $1,940.00 | $4,132.00 |