- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $961.82 / $5,793.75 / $13,012.30
| Facility | | $961.82 | $5,793.75 | $13,012.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $6,246.00 / $13,081.00
| Facility | | $1,917.00 | $6,246.00 | $13,081.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $5,980.00 / $9,904.46
| Facility | | $500.00 | $5,980.00 | $9,904.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,271.16 / $10,271.16
| Facility | | $55.00 | $10,271.16 | $10,271.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $7,232.00 / $12,407.00
| Facility | | $1,697.00 | $7,232.00 | $12,407.00 |