- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.25 / $4,673.00 / $9,870.00
| Facility | | $126.25 | $4,673.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $1,045.50 / $2,119.98
| Facility | | $603.00 | $1,045.50 | $2,119.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $569.33 / $663.59
| Facility | | $375.00 | $569.33 | $663.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.31 / $132.56 / $215.86
| Facility | | $107.31 | $132.56 | $215.86 |
- 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 |