- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.34 / $2,318.00 / $14,063.00
| Facility | | $1,007.34 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $10,288.00 / $26,304.00
| Facility | | $2,310.00 | $10,288.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.62 / $1,306.10 / $1,975.64
| Facility | | $975.62 | $1,306.10 | $1,975.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $646.00 / $4,441.14
| Facility | | $450.00 | $646.00 | $4,441.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.00 / $9,550.00 / $15,750.00
| Facility | | $2,529.00 | $9,550.00 | $15,750.00 |