- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.67 / $1,500.00 / $9,727.00
| Facility | | $115.67 | $1,500.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $2,106.27 / $3,821.14
| Facility | | $780.00 | $2,106.27 | $3,821.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $480.45 / $617.39
| Facility | | $375.00 | $480.45 | $617.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.16 / $133.02 / $212.93
| Facility | | $96.16 | $133.02 | $212.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |