- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.12 / $4,590.00 / $10,635.00
| Facility | | $661.12 | $4,590.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.32 / $415.58 / $649.35
| Facility | | $346.32 | $415.58 | $649.35 |
- 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
- $2,466.00 / $4,404.00 / $6,831.00
| Facility | | $2,466.00 | $4,404.00 | $6,831.00 |