- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.34 / $2,485.00 / $10,635.00
| Facility | | $138.34 | $2,485.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.00 / $2,012.00 / $3,943.00
| Facility | | $1,051.00 | $2,012.00 | $3,943.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.35 / $106.02 / $165.66
| Facility | | $88.35 | $106.02 | $165.66 |
- 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
- $1,020.00 / $1,952.00 / $4,132.00
| Facility | | $1,020.00 | $1,952.00 | $4,132.00 |