- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.52 / $4,695.96 / $10,268.00
| Facility | | $586.52 | $4,695.96 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $3,405.00 / $14,996.00
| Facility | | $1,525.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.11 / $392.87 / $521.78
| Facility | | $306.11 | $392.87 | $521.78 |
- 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
- $393.56 / $393.56 / $393.56
| Facility | | $393.56 | $393.56 | $393.56 |
- 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 |