- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.43 / $2,040.81 / $16,467.00
| Facility | | $913.43 | $2,040.81 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.35 / $4,017.57 / $7,143.44
| Facility | | $382.35 | $4,017.57 | $7,143.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.58 / $951.00 / $1,552.83
| Facility | | $791.58 | $951.00 | $1,552.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |