- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.05 / $3,158.00 / $10,439.00
| Facility | | $603.05 | $3,158.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.48 / $426.48 / $426.48
| Facility | | $426.48 | $426.48 | $426.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $826.00 / $826.00
| Facility | | $800.00 | $826.00 | $826.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.71 / $502.55 / $1,031.09
| Facility | | $191.71 | $502.55 | $1,031.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,081.00 / $3,918.00
| Facility | | $816.00 | $2,081.00 | $3,918.00 |