- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.50 / $3,232.00 / $12,154.00
| Facility | | $595.50 | $3,232.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.00 / $1,620.02 / $4,019.88
| Facility | | $1,156.00 | $1,620.02 | $4,019.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,968.00 / $27,391.00 / $34,239.00
| Facility | | $22,968.00 | $27,391.00 | $34,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.70 / $645.45 / $19,842.00
| Facility | | $286.70 | $645.45 | $19,842.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $611.00 / $34,510.00
| Facility | | $376.00 | $611.00 | $34,510.00 |