- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.41 / $3,325.00 / $10,268.00
| Facility | | $568.41 | $3,325.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $2,909.00 / $8,800.00
| Facility | | $1,152.00 | $2,909.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.56 / $443.47 / $548.89
| Facility | | $369.56 | $443.47 | $548.89 |
- 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 |