- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.73 / $6,072.00 / $11,581.00
| Facility | | $591.73 | $6,072.00 | $11,581.00 |
- 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
- $303.62 / $389.68 / $517.54
| Facility | | $303.62 | $389.68 | $517.54 |
- 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
- $392.07 / $392.07 / $392.07
| Facility | | $392.07 | $392.07 | $392.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.00 / $2,869.00 / $5,457.00
| Facility | | $1,771.00 | $2,869.00 | $5,457.00 |