- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.25 / $6,041.00 / $12,174.00
| Facility | | $662.25 | $6,041.00 | $12,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,286.00 / $10,011.00
| Facility | | $2,088.00 | $4,286.00 | $10,011.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,285.00 / $13,118.00 / $15,563.00
| Facility | | $10,285.00 | $13,118.00 | $15,563.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.87 / $859.37 / $16,020.12
| Facility | | $372.87 | $859.37 | $16,020.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,516.00 / $5,800.00 / $10,781.00
| Facility | | $2,516.00 | $5,800.00 | $10,781.00 |