- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.13 / $2,547.00 / $10,635.00
| Facility | | $595.13 | $2,547.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,392.00 / $14,996.00
| Facility | | $1,712.00 | $3,392.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.78 / $470.74 / $625.20
| Facility | | $366.78 | $470.74 | $625.20 |
- 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
- $471.30 / $471.30 / $471.30
| Facility | | $471.30 | $471.30 | $471.30 |
- 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 |