- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,694.00 / $6,012.00
| Facility | | $941.00 | $2,694.00 | $6,012.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,377.15 / $20,122.27 / $42,387.73
| Facility | | $11,377.15 | $20,122.27 | $42,387.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.21 / $37,725.76 / $37,725.76
| Facility | | $812.21 | $37,725.76 | $37,725.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.00 / $8,928.00 / $24,051.00
| Facility | | $1,215.00 | $8,928.00 | $24,051.00 |