- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.24 / $3,843.00 / $10,439.00
| Facility | | $679.24 | $3,843.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,647.06 / $6,069.38
| Facility | | $2,597.30 | $3,647.06 | $6,069.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $442.00 / $442.00
| Facility | | $442.00 | $442.00 | $442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.21 / $855.56 / $5,562.00
| Facility | | $541.21 | $855.56 | $5,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,562.00
| Facility | | $1,436.00 | $3,096.00 | $5,562.00 |