- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.03 / $2,292.00 / $9,534.00
| Facility | | $433.03 | $2,292.00 | $9,534.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $2,742.00 / $8,800.00
| Facility | | $1,152.00 | $2,742.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.56 / $373.87 / $462.75
| Facility | | $311.56 | $373.87 | $462.75 |
- 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 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |