- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.32 / $6,942.00 / $13,151.00
| Facility | | $894.32 | $6,942.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $2,151.96 / $3,479.19
| Facility | | $1,461.10 | $2,151.96 | $3,479.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $985.00 / $985.00
| Facility | | $985.00 | $985.00 | $985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.30 / $816.00 / $3,561.00
| Facility | | $521.30 | $816.00 | $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 |