- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.16 / $3,500.00 / $19,777.75
| Facility | | $477.16 | $3,500.00 | $19,777.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,932.00 / $6,503.00 / $56,650.00
| Facility | | $2,932.00 | $6,503.00 | $56,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.44 / $702.27 / $1,053.41
| Facility | | $497.44 | $702.27 | $1,053.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,940.69 / $26,940.69 / $26,940.69
| Facility | | $26,940.69 | $26,940.69 | $26,940.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,665.00 / $16,557.00 / $34,320.00
| Facility | | $10,665.00 | $16,557.00 | $34,320.00 |