- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.55 / $2,905.00 / $10,268.00
| Facility | | $365.55 | $2,905.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,405.00 / $14,996.00
| Facility | | $1,760.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.45 / $396.02 / $465.90
| Facility | | $253.45 | $396.02 | $465.90 |
- 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 / $4,138.00 / $6,522.00
| Facility | | $2,233.00 | $4,138.00 | $6,522.00 |