- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.01 / $3,213.00 / $7,365.00
| Facility | | $301.01 | $3,213.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.00 / $1,581.00 / $3,523.00
| Facility | | $770.00 | $1,581.00 | $3,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,323.00 / $9,803.00 / $11,140.00
| Facility | | $6,323.00 | $9,803.00 | $11,140.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.60 / $431.10 / $2,831.00
| Facility | | $178.60 | $431.10 | $2,831.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,332.00 / $3,074.00
| Facility | | $1,216.00 | $2,332.00 | $3,074.00 |