- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.34 / $2,833.00 / $11,627.00
| Facility | | $1,121.34 | $2,833.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.00 / $8,566.00 / $60,320.00
| Facility | | $2,550.00 | $8,566.00 | $60,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.78 / $858.94 / $1,063.10
| Facility | | $715.78 | $858.94 | $1,063.10 |
- 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
- $4,524.00 / $11,766.00 / $20,348.00
| Facility | | $4,524.00 | $11,766.00 | $20,348.00 |