- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.20 / $5,135.00 / $11,627.00
| Facility | | $906.20 | $5,135.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $7,949.51 / $14,996.00
| Facility | | $3,405.00 | $7,949.51 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.07 / $1,150.88 / $1,424.47
| Facility | | $959.07 | $1,150.88 | $1,424.47 |
- 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
- $1,771.00 / $3,098.00 / $6,792.00
| Facility | | $1,771.00 | $3,098.00 | $6,792.00 |