- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.82 / $5,063.72 / $10,956.00
| Facility | | $591.82 | $5,063.72 | $10,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,405.00 / $14,996.00
| Facility | | $1,712.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.31 / $413.66 / $549.41
| Facility | | $322.31 | $413.66 | $549.41 |
- 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
- $417.74 / $417.74 / $417.74
| Facility | | $417.74 | $417.74 | $417.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,223.00 / $6,522.00
| Facility | | $2,233.00 | $4,223.00 | $6,522.00 |