- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.76 / $4,723.00 / $11,627.00
| Facility | | $565.76 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.00 / $9,381.99 / $16,655.00
| Facility | | $3,392.00 | $9,381.99 | $16,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.63 / $658.36 / $814.85
| Facility | | $548.63 | $658.36 | $814.85 |
- 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 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |