- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.62 / $2,547.00 / $10,635.00
| Facility | | $692.62 | $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
- $440.15 / $528.17 / $653.74
| Facility | | $440.15 | $528.17 | $653.74 |
- 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 |