- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.50 / $2,640.00 / $7,139.00
| Facility | | $562.50 | $2,640.00 | $7,139.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.79 / $2,064.02 / $3,616.69
| Facility | | $552.79 | $2,064.02 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.19 / $711.68 / $1,166.08
| Facility | | $538.19 | $711.68 | $1,166.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.25 / $326.95 / $653.02
| Facility | | $238.25 | $326.95 | $653.02 |
- 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 |