- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.66 / $4,947.00 / $11,581.00
| Facility | | $663.66 | $4,947.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.00 / $3,025.00 / $8,800.00
| Facility | | $1,191.00 | $3,025.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.07 / $525.67 / $821.39
| Facility | | $438.07 | $525.67 | $821.39 |
- 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
- $2,647.00 / $4,410.00 / $7,351.00
| Facility | | $2,647.00 | $4,410.00 | $7,351.00 |