- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.13 / $7,155.00 / $11,581.00
| Facility | | $499.13 | $7,155.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $5,563.00 / $29,406.00
| Facility | | $1,895.00 | $5,563.00 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.32 / $384.38 / $475.76
| Facility | | $320.32 | $384.38 | $475.76 |
- 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 |