- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.88 / $568.23 / $2,525.00
| Facility | | $360.88 | $568.23 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.48 / $4,844.72 / $10,098.06
| Facility | | $707.48 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.44 / $1,960.07 / $4,715.21
| Facility | | $1,381.44 | $1,960.07 | $4,715.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.49 / $1,791.97 / $3,712.76
| Facility | | $1,213.49 | $1,791.97 | $3,712.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.74 / $740.16 / $1,525.26
| Facility | | $398.74 | $740.16 | $1,525.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |