- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.52 / $3,785.00 / $10,268.00
| Facility | | $866.52 | $3,785.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $5,770.00 / $30,285.00
| Facility | | $2,777.00 | $5,770.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.63 / $695.14 / $860.38
| Facility | | $541.63 | $695.14 | $860.38 |
- 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
- $694.13 / $694.13 / $694.13
| Facility | | $694.13 | $694.13 | $694.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |