- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.42 / $3,278.00 / $10,635.00
| Facility | | $309.42 | $3,278.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.00 / $2,141.00 / $3,111.00
| Facility | | $772.00 | $2,141.00 | $3,111.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.93 / $226.84 / $330.31
| Facility | | $207.93 | $226.84 | $330.31 |
- 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
- $265.26 / $265.26 / $1,504.17
| Facility | | $265.26 | $265.26 | $1,504.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.00 / $965.00 / $2,914.00
| Facility | | $444.00 | $965.00 | $2,914.00 |