- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.49 / $4,230.00 / $9,870.00
| Facility | | $576.49 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $1,652.14 / $2,887.55
| Facility | | $780.00 | $1,652.14 | $2,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,176.85 / $1,512.28
| Facility | | $375.00 | $1,176.85 | $1,512.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.29 / $515.80 / $1,087.43
| Facility | | $402.29 | $515.80 | $1,087.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.00 / $10,147.00 / $16,816.00
| Facility | | $2,764.00 | $10,147.00 | $16,816.00 |