- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.30 / $8,553.00 / $12,565.00
| Facility | | $736.30 | $8,553.00 | $12,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,173.00 / $36,529.00
| Facility | | $2,097.00 | $8,173.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.28 / $432.28 / $629.45
| Facility | | $432.28 | $432.28 | $629.45 |
- 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
- $4,873.00 / $11,553.00 / $30,266.00
| Facility | | $4,873.00 | $11,553.00 | $30,266.00 |