- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.08 / $4,723.00 / $11,627.00
| Facility | | $793.08 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $12,094.63 / $21,233.00
| Facility | | $4,142.00 | $12,094.63 | $21,233.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.15 / $921.78 / $1,140.90
| Facility | | $768.15 | $921.78 | $1,140.90 |
- 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
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |