- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.35 / $4,846.00 / $15,539.86
| Facility | | $420.35 | $4,846.00 | $15,539.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.00 / $26,904.00 / $50,875.00
| Facility | | $1,646.00 | $26,904.00 | $50,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.52 / $422.53 / $487.53
| Facility | | $331.52 | $422.53 | $487.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,910.42 / $7,910.42 / $7,910.42
| Facility | | $7,910.42 | $7,910.42 | $7,910.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,296.00 / $17,380.00
| Facility | | $5,431.00 | $12,296.00 | $17,380.00 |