- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.08 / $4,590.00 / $10,635.00
| Facility | | $765.08 | $4,590.00 | $10,635.00 |
- 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
- $472.15 / $515.08 / $750.03
| Facility | | $472.15 | $515.08 | $750.03 |
- 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
- $606.71 / $606.71 / $606.71
| Facility | | $606.71 | $606.71 | $606.71 |
- 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 |