- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.51 / $4,387.00 / $10,439.00
| Facility | | $820.51 | $4,387.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.00 / $1,620.02 / $2,568.26
| Facility | | $1,198.00 | $1,620.02 | $2,568.26 |
- 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
- $488.40 / $812.94 / $4,510.00
| Facility | | $488.40 | $812.94 | $4,510.00 |
- 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 |