- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.07 / $3,278.00 / $10,268.00
| Facility | | $598.07 | $3,278.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $5,544.00 / $30,285.00
| Facility | | $2,670.00 | $5,544.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.32 / $346.16 / $504.06
| Facility | | $317.32 | $346.16 | $504.06 |
- 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
- $411.59 / $411.59 / $411.59
| Facility | | $411.59 | $411.59 | $411.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |