- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.54 / $4,376.00 / $12,154.00
| Facility | | $772.54 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,025.40 / $2,843.96 / $4,734.39
| Facility | | $2,025.40 | $2,843.96 | $4,734.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.00 / $8,660.00 / $8,660.00
| Facility | | $1,326.00 | $8,660.00 | $8,660.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.15 / $772.21 / $3,561.00
| Facility | | $454.15 | $772.21 | $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 |