- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.64 / $4,044.00 / $10,268.00
| Facility | | $285.64 | $4,044.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.00 / $292.68 / $292.68
| Facility | | $201.00 | $292.68 | $292.68 |
- 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
- $2,840.00 / $5,513.00 / $7,847.00
| Facility | | $2,840.00 | $5,513.00 | $7,847.00 |