- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.00 / $3,325.00 / $11,581.00
| Facility | | $1,174.00 | $3,325.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $5,563.00 / $29,406.00
| Facility | | $1,895.00 | $5,563.00 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.43 / $916.12 / $1,431.44
| Facility | | $763.43 | $916.12 | $1,431.44 |
- 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
- $2,466.00 / $4,404.00 / $6,831.00
| Facility | | $2,466.00 | $4,404.00 | $6,831.00 |