- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.78 / $2,113.00 / $10,268.00
| Facility | | $472.78 | $2,113.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.00 / $3,554.00 / $19,117.00
| Facility | | $1,861.00 | $3,554.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.59 / $443.51 / $692.99
| Facility | | $369.59 | $443.51 | $692.99 |
- 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 |