- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.10 / $6,251.00 / $11,581.00
| Facility | | $1,200.10 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,092.00 / $13,240.08 / $22,636.66
| Facility | | $3,092.00 | $13,240.08 | $22,636.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.90 / $706.90 / $1,029.33
| Facility | | $706.90 | $706.90 | $1,029.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |