- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.24 / $3,000.00 / $11,093.00
| Facility | | $792.24 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,774.00 / $7,944.00 / $41,809.35
| Facility | | $3,774.00 | $7,944.00 | $41,809.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.35 / $813.64 / $920.41
| Facility | | $782.35 | $813.64 | $920.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,153.57 / $23,153.57 / $23,153.57
| Facility | | $23,153.57 | $23,153.57 | $23,153.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,376.00 / $15,721.00 / $25,270.00
| Facility | | $10,376.00 | $15,721.00 | $25,270.00 |