- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.30 / $1,691.00 / $14,516.00
| Facility | | $1,090.30 | $1,691.00 | $14,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $28,053.00
| Facility | | $606.10 | $606.10 | $28,053.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.27 / $1,143.13 / $1,929.57
| Facility | | $949.27 | $1,143.13 | $1,929.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,209.12 / $10,209.12
| Facility | | $55.00 | $10,209.12 | $10,209.12 |