- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.05 / $2,113.00 / $10,268.00
| Facility | | $281.05 | $2,113.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,392.00 / $14,996.00
| Facility | | $1,712.00 | $3,392.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.40 / $241.68 / $299.13
| Facility | | $201.40 | $241.68 | $299.13 |
- 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 |