- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.19 / $3,325.00 / $11,581.00
| Facility | | $395.19 | $3,325.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $7,398.00 / $36,529.00
| Facility | | $2,097.00 | $7,398.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.68 / $220.68 / $321.33
| Facility | | $220.68 | $220.68 | $321.33 |
- 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 / $5,920.00 / $7,847.00
| Facility | | $2,840.00 | $5,920.00 | $7,847.00 |