- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.01 / $369.51 / $2,168.00
| Facility | | $213.01 | $369.51 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.69 / $5,792.97 / $11,146.35
| Facility | | $2,729.69 | $5,792.97 | $11,146.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.66 / $1,263.71 / $3,040.03
| Facility | | $890.66 | $1,263.71 | $3,040.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.41 / $1,155.33 / $2,393.73
| Facility | | $724.41 | $1,155.33 | $2,393.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.22 / $472.08 / $986.64
| Facility | | $235.22 | $472.08 | $986.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |