- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.28 / $3,602.00 / $10,635.00
| Facility | | $253.28 | $3,602.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $2,894.00 / $8,800.00
| Facility | | $1,152.00 | $2,894.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.63 / $197.56 / $244.51
| Facility | | $164.63 | $197.56 | $244.51 |
- 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
- $2,466.00 / $4,404.00 / $6,522.00
| Facility | | $2,466.00 | $4,404.00 | $6,522.00 |