- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.84 / $3,637.00 / $10,439.00
| Facility | | $663.84 | $3,637.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.00 / $1,803.72 / $1,898.65
| Facility | | $566.00 | $1,803.72 | $1,898.65 |
- 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
- $364.71 / $664.78 / $3,561.00
| Facility | | $364.71 | $664.78 | $3,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |