- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.20 / $4,375.00 / $16,467.00
| Facility | | $361.20 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,588.93 / $3,640.46 / $6,060.17
| Facility | | $1,588.93 | $3,640.46 | $6,060.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.80 / $357.41 / $580.00
| Facility | | $210.80 | $357.41 | $580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.64 / $402.00 / $661.15
| Facility | | $331.64 | $402.00 | $661.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |