- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.16 / $3,972.12 / $10,439.00
| Facility | | $520.16 | $3,972.12 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.00 / $2,324.23 / $3,130.84
| Facility | | $838.00 | $2,324.23 | $3,130.84 |
- 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
- $331.69 / $520.16 / $4,510.00
| Facility | | $331.69 | $520.16 | $4,510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $2,976.26 / $5,562.00
| Facility | | $1,436.00 | $2,976.26 | $5,562.00 |