- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.11 / $6,072.00 / $11,581.00
| Facility | | $683.11 | $6,072.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,792.00 / $8,800.00
| Facility | | $1,145.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.13 / $450.65 / $598.52
| Facility | | $351.13 | $450.65 | $598.52 |
- 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
- $452.71 / $452.71 / $452.71
| Facility | | $452.71 | $452.71 | $452.71 |
- 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 |