- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.36 / $6,548.00 / $16,467.00
| Facility | | $272.36 | $6,548.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $5,805.50 / $10,098.66
| Facility | | $1,058.00 | $5,805.50 | $10,098.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $3,138.85
| Facility | | $375.00 | $615.00 | $3,138.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.14 / $410.14 / $518.55
| Facility | | $254.14 | $410.14 | $518.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |