- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.76 / $1,806.09 / $7,212.00
| Facility | | $702.76 | $1,806.09 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,591.00 / $6,340.00 / $37,919.46
| Facility | | $2,591.00 | $6,340.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.87 / $892.00 / $1,029.23
| Facility | | $699.87 | $892.00 | $1,029.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,307.88 / $14,307.88 / $14,307.88
| Facility | | $14,307.88 | $14,307.88 | $14,307.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,161.00 / $13,780.00 / $22,576.00
| Facility | | $6,161.00 | $13,780.00 | $22,576.00 |