- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.69 / $4,028.00 / $15,063.00
| Facility | | $720.69 | $4,028.00 | $15,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,434.00 / $9,272.00
| Facility | | $2,367.00 | $5,434.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,483.00 / $26,483.00 / $26,483.00
| Facility | | $26,483.00 | $26,483.00 | $26,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.95 / $33,479.25 / $33,479.25
| Facility | | $1,697.95 | $33,479.25 | $33,479.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,362.00
| Facility | | $3,964.00 | $8,273.00 | $12,362.00 |