- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.39 / $4,375.00 / $16,467.00
| Facility | | $496.39 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $4,545.93 / $8,090.25
| Facility | | $2,187.00 | $4,545.93 | $8,090.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.09 / $890.00 / $1,370.63
| Facility | | $498.09 | $890.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.80 / $532.00 / $916.61
| Facility | | $441.80 | $532.00 | $916.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |