- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.58 / $5,467.00 / $12,237.00
| Facility | | $831.58 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.10 / $3,118.38 / $3,726.84
| Facility | | $1,594.10 | $3,118.38 | $3,726.84 |
- 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
- $494.99 / $773.55 / $5,562.00
| Facility | | $494.99 | $773.55 | $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 |