- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,485.00 / $10,268.00
| Facility | | $500.00 | $2,485.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.00 / $1,981.00 / $3,943.00
| Facility | | $1,051.00 | $1,981.00 | $3,943.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.43 / $377.32 / $467.01
| Facility | | $314.43 | $377.32 | $467.01 |
- 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 / $979.00 / $3,218.00
| Facility | | $444.00 | $979.00 | $3,218.00 |