- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.59 / $3,776.00 / $9,870.00
| Facility | | $134.59 | $3,776.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.27 / $1,193.74 / $2,213.48
| Facility | | $529.27 | $1,193.74 | $2,213.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $440.00 / $645.24
| Facility | | $375.00 | $440.00 | $645.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.34 / $182.48 / $289.79
| Facility | | $126.34 | $182.48 | $289.79 |
- 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 |