- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.25 / $5,201.00 / $11,581.00
| Facility | | $257.25 | $5,201.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.00 / $2,170.00 / $6,565.00
| Facility | | $937.00 | $2,170.00 | $6,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.21 / $276.11 / $1,021.85
| Facility | | $225.21 | $276.11 | $1,021.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.88 / $208.88 / $21,571.00
| Facility | | $208.88 | $208.88 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.00 / $881.00 / $2,833.00
| Facility | | $226.00 | $881.00 | $2,833.00 |