- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.62 / $2,849.00 / $10,268.00
| Facility | | $326.62 | $2,849.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,792.00 / $8,800.00
| Facility | | $1,145.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.05 / $205.26 / $254.05
| Facility | | $171.05 | $205.26 | $254.05 |
- 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
- $1,689.00 / $2,665.00 / $5,268.00
| Facility | | $1,689.00 | $2,665.00 | $5,268.00 |