- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.76 / $3,701.00 / $10,439.00
| Facility | | $695.76 | $3,701.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.20 / $1,620.02 / $2,568.26
| Facility | | $1,098.20 | $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
- $427.48 / $695.76 / $4,510.00
| Facility | | $427.48 | $695.76 | $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 |