- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.12 / $4,376.00 / $12,154.00
| Facility | | $691.12 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.10 / $2,350.44 / $3,726.84
| Facility | | $1,594.10 | $2,350.44 | $3,726.84 |
- 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
- $374.28 / $690.63 / $3,561.00
| Facility | | $374.28 | $690.63 | $3,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.00 / $3,125.00 / $5,565.00
| Facility | | $1,521.00 | $3,125.00 | $5,565.00 |