- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.11 / $3,776.00 / $9,870.00
| Facility | | $228.11 | $3,776.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $1,000.00 / $3,729.17
| Facility | | $603.00 | $1,000.00 | $3,729.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $1,139.16
| Facility | | $375.00 | $615.00 | $1,139.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.63 / $226.03 / $387.79
| Facility | | $190.63 | $226.03 | $387.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.00 / $6,172.00 / $8,667.00
| Facility | | $586.00 | $6,172.00 | $8,667.00 |