- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.67 / $4,046.35 / $9,516.00
| Facility | | $394.67 | $4,046.35 | $9,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $3,025.00 / $8,800.00
| Facility | | $1,152.00 | $3,025.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.49 / $251.39 / $311.14
| Facility | | $209.49 | $251.39 | $311.14 |
- 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 |