- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.04 / $3,821.00 / $12,600.00
| Facility | | $924.04 | $3,821.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,997.28 / $12,508.22 / $19,618.43
| Facility | | $7,997.28 | $12,508.22 | $19,618.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,409.55 / $7,409.55 / $7,409.55
| Facility | | $7,409.55 | $7,409.55 | $7,409.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.74 / $1,029.83 / $13,541.98
| Facility | | $677.74 | $1,029.83 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |