- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.09 / $3,776.00 / $9,727.00
| Facility | | $106.09 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.03 / $1,658.29 / $2,887.55
| Facility | | $808.03 | $1,658.29 | $2,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.55 / $780.00 / $781.44
| Facility | | $153.55 | $780.00 | $781.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.09 / $172.64 / $265.94
| Facility | | $106.09 | $172.64 | $265.94 |
- 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 |