- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.95 / $2,113.00 / $10,268.00
| Facility | | $408.95 | $2,113.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,242.00 / $19,117.00
| Facility | | $1,794.00 | $3,242.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.43 / $384.52 / $600.80
| Facility | | $320.43 | $384.52 | $600.80 |
- 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
- $1,689.00 / $2,665.00 / $5,268.00
| Facility | | $1,689.00 | $2,665.00 | $5,268.00 |