- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.98 / $4,723.00 / $11,627.00
| Facility | | $692.98 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,129.00 / $24,806.46 / $43,597.54
| Facility | | $5,129.00 | $24,806.46 | $43,597.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.77 / $806.12 / $997.75
| Facility | | $671.77 | $806.12 | $997.75 |
- 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
- $4,070.00 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |