- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.28 / $5,866.00 / $16,467.00
| Facility | | $704.28 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.00 / $48,190.46 / $105,855.81
| Facility | | $1,737.00 | $48,190.46 | $105,855.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.61 / $890.00 / $43,884.32
| Facility | | $685.61 | $890.00 | $43,884.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.23 / $848.01 / $1,405.42
| Facility | | $679.23 | $848.01 | $1,405.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $27,755.00 / $70,357.00
| Facility | | $4,200.00 | $27,755.00 | $70,357.00 |