- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.86 / $3,999.00 / $10,268.00
| Facility | | $311.86 | $3,999.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $3,025.00 / $8,800.00
| Facility | | $1,152.00 | $3,025.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $341.34 / $341.34
| Facility | | $234.42 | $341.34 | $341.34 |
- 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 |