- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.88 / $8,553.00 / $11,627.00
| Facility | | $510.88 | $8,553.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,287.00 / $14,996.00
| Facility | | $1,712.00 | $3,287.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.67 / $579.20 / $716.89
| Facility | | $482.67 | $579.20 | $716.89 |
- 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 |