- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.77 / $4,192.00 / $13,200.00
| Facility | | $746.77 | $4,192.00 | $13,200.00 |
- 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
- $7,299.67 / $7,299.67 / $7,299.67
| Facility | | $7,299.67 | $7,299.67 | $7,299.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.19 / $810.45 / $14,063.00
| Facility | | $580.19 | $810.45 | $14,063.00 |
- 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 |