- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.63 / $2,121.83 / $54,967.00
| Facility | | $999.63 | $2,121.83 | $54,967.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,326.00 / $5,065.00
| Facility | | $1,270.00 | $2,326.00 | $5,065.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,877.75 / $25,867.00 / $33,043.00
| Facility | | $7,877.75 | $25,867.00 | $33,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,209.12 / $10,438.08
| Facility | | $55.00 | $10,209.12 | $10,438.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |