- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.16 / $5,818.00 / $12,154.00
| Facility | | $339.16 | $5,818.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.00 / $309.29 / $651.39
| Facility | | $227.00 | $309.29 | $651.39 |
- 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
- $250.43 / $610.29 / $1,363.10
| Facility | | $250.43 | $610.29 | $1,363.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |