- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.22 / $2,475.00 / $10,268.00
| Facility | | $106.22 | $2,475.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.00 / $1,927.00 / $3,943.00
| Facility | | $937.00 | $1,927.00 | $3,943.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.88 / $67.37 / $84.27
| Facility | | $57.88 | $67.37 | $84.27 |
- 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
- $276.48 / $276.48 / $276.48
| Facility | | $276.48 | $276.48 | $276.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.00 / $979.00 / $3,218.00
| Facility | | $444.00 | $979.00 | $3,218.00 |