- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.83 / $5,135.00 / $11,627.00
| Facility | | $676.83 | $5,135.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.85 / $1,163.83 / $2,389.00
| Facility | | $562.85 | $1,163.83 | $2,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.34 / $1,088.22 / $1,088.22
| Facility | | $747.34 | $1,088.22 | $1,088.22 |
- 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
- $1,771.00 / $3,086.00 / $6,111.00
| Facility | | $1,771.00 | $3,086.00 | $6,111.00 |