- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.53 / $3,498.00 / $10,439.00
| Facility | | $437.53 | $3,498.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.00 / $2,942.79 / $4,898.12
| Facility | | $2,207.00 | $2,942.79 | $4,898.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.74 / $312.52 / $698.54
| Facility | | $120.74 | $312.52 | $698.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.00 / $1,353.00 / $2,793.00
| Facility | | $525.00 | $1,353.00 | $2,793.00 |