- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.20 / $3,602.00 / $11,627.00
| Facility | | $622.20 | $3,602.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.00 / $4,142.00 / $19,117.00
| Facility | | $2,003.00 | $4,142.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.31 / $451.24 / $564.41
| Facility | | $355.31 | $451.24 | $564.41 |
- 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
- $453.25 / $453.25 / $453.25
| Facility | | $453.25 | $453.25 | $453.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,557.00 / $13,653.00
| Facility | | $3,206.00 | $6,557.00 | $13,653.00 |