- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.25 / $8,047.20 / $49,433.00
| Facility | | $294.25 | $8,047.20 | $49,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.39 / $398.39 / $1,047.99
| Facility | | $398.39 | $398.39 | $1,047.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,825.00 / $14,825.00 / $20,236.00
| Facility | | $14,825.00 | $14,825.00 | $20,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.25 / $511.50 / $678.38
| Facility | | $294.25 | $511.50 | $678.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,679.00 / $22,337.00
| Facility | | $225.00 | $1,679.00 | $22,337.00 |