- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.19 / $5,907.00 / $10,817.74
| Facility | | $749.19 | $5,907.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,909.00 / $8,800.00
| Facility | | $1,145.00 | $2,909.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.35 / $502.02 / $784.41
| Facility | | $418.35 | $502.02 | $784.41 |
- 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
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |