- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.22 / $4,376.00 / $12,154.00
| Facility | | $607.22 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $2,151.96 / $4,532.06
| Facility | | $1,461.10 | $2,151.96 | $4,532.06 |
- 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
- $360.10 / $642.89 / $3,561.00
| Facility | | $360.10 | $642.89 | $3,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.00 / $3,096.00 / $5,562.00
| Facility | | $955.00 | $3,096.00 | $5,562.00 |