- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.93 / $5,355.00 / $10,817.74
| Facility | | $450.93 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $4,616.00 / $25,522.00
| Facility | | $2,291.00 | $4,616.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.00 / $348.00 / $430.73
| Facility | | $290.00 | $348.00 | $430.73 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |