- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.01 / $408.67 / $2,525.00
| Facility | | $262.01 | $408.67 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.75 / $1,635.67 / $2,618.46
| Facility | | $812.75 | $1,635.67 | $2,618.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.19 / $1,452.43 / $3,494.02
| Facility | | $1,024.19 | $1,452.43 | $3,494.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.60 / $1,327.87 / $2,751.20
| Facility | | $832.60 | $1,327.87 | $2,751.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.51 / $509.54 / $1,077.85
| Facility | | $292.51 | $509.54 | $1,077.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |