- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.94 / $4,230.00 / $9,870.00
| Facility | | $358.94 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,340.12 / $20,794.65 / $34,286.00
| Facility | | $9,340.12 | $20,794.65 | $34,286.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.91 / $375.00 / $16,224.40
| Facility | | $354.91 | $375.00 | $16,224.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.54 / $415.00 / $732.08
| Facility | | $336.54 | $415.00 | $732.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $21,721.00 / $47,031.00
| Facility | | $3,340.00 | $21,721.00 | $47,031.00 |