- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.54 / $175.54 / $175.54
| Facility | | $175.54 | $175.54 | $175.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,418.80 / $10,344.04 / $16,319.60
| Facility | | $5,418.80 | $10,344.04 | $16,319.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,239.00 / $32,000.00 / $58,466.00
| Facility | | $21,239.00 | $32,000.00 | $58,466.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.77 / $240.37 / $393.47
| Facility | | $165.77 | $240.37 | $393.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |