- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $878.52 / $4,085.00 / $10,268.00
| Facility | | $878.52 | $4,085.00 | $10,268.00 |
- 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
- $467.29 / $560.75 / $694.06
| Facility | | $467.29 | $560.75 | $694.06 |
- 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 |