- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.03 / $4,723.00 / $11,627.00
| Facility | | $854.03 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $8,450.20 / $15,206.26
| Facility | | $3,315.00 | $8,450.20 | $15,206.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.68 / $972.82 / $1,204.07
| Facility | | $810.68 | $972.82 | $1,204.07 |
- 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
- $2,840.00 / $5,998.00 / $7,847.00
| Facility | | $2,840.00 | $5,998.00 | $7,847.00 |