- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.47 / $445.05 / $3,150.00
| Facility | | $261.47 | $445.05 | $3,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.08 / $1,149.52 / $2,500.33
| Facility | | $524.08 | $1,149.52 | $2,500.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.89 / $1,568.29 / $3,772.74
| Facility | | $1,105.89 | $1,568.29 | $3,772.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.01 / $1,433.80 / $2,970.66
| Facility | | $899.01 | $1,433.80 | $2,970.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.52 / $579.72 / $1,362.14
| Facility | | $306.52 | $579.72 | $1,362.14 |
- 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 |