- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.72 / $3,907.00 / $9,863.00
| Facility | | $157.72 | $3,907.00 | $9,863.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.00 / $2,170.00 / $5,211.00
| Facility | | $891.00 | $2,170.00 | $5,211.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.12 / $154.51 / $154.51
| Facility | | $106.12 | $154.51 | $154.51 |
- 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
- $444.00 / $975.00 / $2,914.00
| Facility | | $444.00 | $975.00 | $2,914.00 |