- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.00 / $4,376.00 / $12,154.00
| Facility | | $883.00 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.65 / $2,471.67 / $2,745.63
| Facility | | $1,127.65 | $2,471.67 | $2,745.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.36 / $572.84 / $5,562.00
| Facility | | $367.36 | $572.84 | $5,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |