- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.50 / $2,300.00 / $5,506.00
| Facility | | $546.50 | $2,300.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,541.29 / $2,700.74
| Facility | | $412.80 | $1,541.29 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.18 / $550.34 / $901.73
| Facility | | $416.18 | $550.34 | $901.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.80 / $163.52 / $1,973.00
| Facility | | $116.80 | $163.52 | $1,973.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,517.00 / $4,486.00
| Facility | | $966.00 | $2,517.00 | $4,486.00 |