- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.06 / $4,375.00 / $16,467.00
| Facility | | $508.06 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.64 / $438.34 / $728.95
| Facility | | $208.64 | $438.34 | $728.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.04 / $580.00 / $2,581.96
| Facility | | $507.04 | $580.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.85 / $552.51 / $948.65
| Facility | | $453.85 | $552.51 | $948.65 |
- 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 |