- 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
- $1,041.20 / $2,052.37 / $2,429.98
| Facility | | $1,041.20 | $2,052.37 | $2,429.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.38 / $804.99 / $2,944.00
| Facility | | $501.38 | $804.99 | $2,944.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.56 / $2,902.00 / $5,562.00
| Facility | | $888.56 | $2,902.00 | $5,562.00 |