- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.83 / $3,589.49 / $10,439.00
| Facility | | $645.83 | $3,589.49 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.90 / $2,722.10 / $4,532.57
| Facility | | $1,939.90 | $2,722.10 | $4,532.57 |
- 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
- $370.41 / $659.22 / $3,561.00
| Facility | | $370.41 | $659.22 | $3,561.00 |
- 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 |