- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.75 / $3,489.00 / $8,604.00
| Facility | | $547.75 | $3,489.00 | $8,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.20 / $1,381.68 / $2,299.67
| Facility | | $984.20 | $1,381.68 | $2,299.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.00 / $800.00 / $2,437.00
| Facility | | $744.00 | $800.00 | $2,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.44 / $658.02 / $1,575.29
| Facility | | $219.44 | $658.02 | $1,575.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $1,786.00 / $3,918.00
| Facility | | $816.00 | $1,786.00 | $3,918.00 |