- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.02 / $4,846.00 / $17,733.63
| Facility | | $379.02 | $4,846.00 | $17,733.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,065.00 / $7,188.00 / $47,518.00
| Facility | | $3,065.00 | $7,188.00 | $47,518.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.07 / $383.72 / $442.76
| Facility | | $301.07 | $383.72 | $442.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,112.70 / $10,112.70 / $10,112.70
| Facility | | $10,112.70 | $10,112.70 | $10,112.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,258.00 / $15,855.00 / $24,051.00
| Facility | | $8,258.00 | $15,855.00 | $24,051.00 |