- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.13 / $4,846.00 / $13,837.00
| Facility | | $381.13 | $4,846.00 | $13,837.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $33,179.40 / $50,875.00
| Facility | | $2,575.00 | $33,179.40 | $50,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.06 / $402.82 / $464.79
| Facility | | $316.06 | $402.82 | $464.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,093.89 / $10,093.89 / $10,093.89
| Facility | | $10,093.89 | $10,093.89 | $10,093.89 |
- 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 |