- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.28 / $3,602.00 / $11,581.00
| Facility | | $371.28 | $3,602.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $3,974.00 / $29,406.00
| Facility | | $1,895.00 | $3,974.00 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.87 / $243.44 / $301.32
| Facility | | $202.87 | $243.44 | $301.32 |
- 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 / $5,998.00 / $7,847.00
| Facility | | $2,840.00 | $5,998.00 | $7,847.00 |