- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.72 / $2,547.00 / $10,635.00
| Facility | | $146.72 | $2,547.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.00 / $2,012.00 / $3,943.00
| Facility | | $1,051.00 | $2,012.00 | $3,943.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.62 / $129.13 / $159.85
| Facility | | $107.62 | $129.13 | $159.85 |
- 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
- $1,020.00 / $1,952.00 / $4,132.00
| Facility | | $1,020.00 | $1,952.00 | $4,132.00 |