- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.43 / $3,027.00 / $10,268.00
| Facility | | $257.43 | $3,027.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,412.00 / $8,800.00
| Facility | | $1,145.00 | $2,412.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.69 / $170.04 / $210.46
| Facility | | $141.69 | $170.04 | $210.46 |
- 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
- $1,771.00 / $2,869.00 / $5,457.00
| Facility | | $1,771.00 | $2,869.00 | $5,457.00 |