- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.96 / $11,018.00 / $60,823.00
| Facility | | $532.96 | $11,018.00 | $60,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $5,677.88 / $9,815.44
| Facility | | $2,187.00 | $5,677.88 | $9,815.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $2,486.00 / $3,194.56
| Facility | | $2,486.00 | $2,486.00 | $3,194.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.11 / $588.00 / $908.19
| Facility | | $407.11 | $588.00 | $908.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |