- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.08 / $4,375.00 / $16,467.00
| Facility | | $663.08 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,253.54 / $10,253.54 / $10,253.54
| Facility | | $10,253.54 | $10,253.54 | $10,253.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.67 / $669.67 / $890.00
| Facility | | $669.67 | $669.67 | $890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.91 / $775.54 / $1,317.74
| Facility | | $637.91 | $775.54 | $1,317.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |