- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.09 / $2,822.00 / $5,454.00
| Facility | | $710.09 | $2,822.00 | $5,454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,820.68 / $26,542.00
| Facility | | $1,061.00 | $3,820.68 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $6,493.89
| Facility | | $956.00 | $1,051.59 | $6,493.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.41 / $1,484.02 / $6,679.00
| Facility | | $687.41 | $1,484.02 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,101.95 / $15,101.95 / $15,101.95
| Facility | | $15,101.95 | $15,101.95 | $15,101.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |