- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.33 / $3,776.00 / $9,727.00
| Facility | | $372.33 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.03 / $1,729.68 / $3,166.46
| Facility | | $808.03 | $1,729.68 | $3,166.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.15 / $580.00 / $781.44
| Facility | | $548.15 | $580.00 | $781.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.33 / $746.34 / $1,192.63
| Facility | | $372.33 | $746.34 | $1,192.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $3,866.00 / $6,584.00
| Facility | | $490.00 | $3,866.00 | $6,584.00 |