- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.63 / $1,190.61 / $9,727.00
| Facility | | $200.63 | $1,190.61 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.80 / $5,908.67 / $10,140.68
| Facility | | $2,251.80 | $5,908.67 | $10,140.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $2,106.17 / $2,706.47
| Facility | | $505.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.63 / $398.86 / $914.00
| Facility | | $200.63 | $398.86 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |