- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.33 / $6,410.00 / $13,514.00
| Facility | | $611.33 | $6,410.00 | $13,514.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,173.00 / $36,529.00
| Facility | | $2,097.00 | $8,173.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.48 / $337.48 / $491.41
| Facility | | $337.48 | $337.48 | $491.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,082.37 / $10,082.37 / $10,082.37
| Facility | | $10,082.37 | $10,082.37 | $10,082.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $11,553.00 / $30,266.00
| Facility | | $4,873.00 | $11,553.00 | $30,266.00 |