- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.32 / $1,866.00 / $10,268.00
| Facility | | $304.32 | $1,866.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $16,655.00
| Facility | | $1,760.00 | $3,576.00 | $16,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.45 / $258.37 / $323.18
| Facility | | $203.45 | $258.37 | $323.18 |
- 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
- $391.17 / $391.17 / $391.17
| Facility | | $391.17 | $391.17 | $391.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.48 / $5,120.00 / $7,853.00
| Facility | | $2,550.48 | $5,120.00 | $7,853.00 |