- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.12 / $443.92 / $6,575.00
| Facility | | $318.12 | $443.92 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.27 / $3,057.02 / $6,480.74
| Facility | | $634.27 | $3,057.02 | $6,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.74 / $1,592.18 / $3,830.21
| Facility | | $1,122.74 | $1,592.18 | $3,830.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.71 / $1,455.64 / $3,015.91
| Facility | | $912.71 | $1,455.64 | $3,015.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.40 / $626.90 / $1,183.84
| Facility | | $367.40 | $626.90 | $1,183.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |