- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.50 / $787.00 / $8,229.00
| Facility | | $280.50 | $787.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.64 / $412.82 / $476.22
| Facility | | $301.64 | $412.82 | $476.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.33 / $364.25 / $364.25
| Facility | | $283.33 | $364.25 | $364.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |