- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.37 / $2,485.00 / $10,268.00
| Facility | | $559.37 | $2,485.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,722.00 / $8,800.00
| Facility | | $1,145.00 | $2,722.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.56 / $498.06 / $725.24
| Facility | | $456.56 | $498.06 | $725.24 |
- 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
- $588.11 / $588.11 / $588.11
| Facility | | $588.11 | $588.11 | $588.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,223.00 / $6,502.00
| Facility | | $2,233.00 | $4,223.00 | $6,502.00 |