- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.22 / $5,201.00 / $11,627.00
| Facility | | $739.22 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,674.00 / $8,800.00
| Facility | | $1,145.00 | $2,674.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.03 / $558.04 / $690.69
| Facility | | $465.03 | $558.04 | $690.69 |
- 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 / $1,952.00 / $4,132.00
| Facility | | $1,020.00 | $1,952.00 | $4,132.00 |