- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.43 / $2,895.00 / $10,268.00
| Facility | | $187.43 | $2,895.00 | $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
- $121.62 / $177.09 / $177.09
| Facility | | $121.62 | $177.09 | $177.09 |
- 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 |