- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.85 / $4,886.00 / $11,581.00
| Facility | | $493.85 | $4,886.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.70 / $491.64 / $652.97
| Facility | | $409.70 | $491.64 | $652.97 |
- 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
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |