- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.52 / $342.00 / $2,168.00
| Facility | | $162.52 | $342.00 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.37 / $2,322.81 / $5,989.80
| Facility | | $914.37 | $2,322.81 | $5,989.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.11 / $1,218.32 / $2,930.84
| Facility | | $859.11 | $1,218.32 | $2,930.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.46 / $1,113.83 / $2,307.75
| Facility | | $676.46 | $1,113.83 | $2,307.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.60 / $379.20 / $1,046.71
| Facility | | $189.60 | $379.20 | $1,046.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |