- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.98 / $4,723.00 / $11,627.00
| Facility | | $78.98 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.67 / $4,089.29 / $7,640.32
| Facility | | $1,965.67 | $4,089.29 | $7,640.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.80 / $100.87 / $124.85
| Facility | | $81.80 | $100.87 | $124.85 |
- 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 |