- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.11 / $5,267.52 / $10,635.00
| Facility | | $527.11 | $5,267.52 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $4,616.00 / $25,522.00
| Facility | | $2,291.00 | $4,616.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.75 / $347.70 / $430.35
| Facility | | $289.75 | $347.70 | $430.35 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |