- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.31 / $2,849.00 / $10,268.00
| Facility | | $417.31 | $2,849.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,443.00 / $8,800.00
| Facility | | $1,145.00 | $2,443.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.13 / $460.33 / $460.33
| Facility | | $316.13 | $460.33 | $460.33 |
- 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
- $1,689.00 / $2,551.00 / $5,235.00
| Facility | | $1,689.00 | $2,551.00 | $5,235.00 |