- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.41 / $4,846.00 / $7,212.00
| Facility | | $917.41 | $4,846.00 | $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
- $870.01 / $1,108.83 / $1,279.43
| Facility | | $870.01 | $1,108.83 | $1,279.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,405.61 / $6,405.61 / $6,405.61
| Facility | | $6,405.61 | $6,405.61 | $6,405.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |