- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.32 / $375.20 / $2,525.00
| Facility | | $158.32 | $375.20 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.87 / $2,831.53 / $6,031.72
| Facility | | $731.87 | $2,831.53 | $6,031.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.95 / $1,242.21 / $2,988.31
| Facility | | $875.95 | $1,242.21 | $2,988.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.09 / $1,135.68 / $2,353.00
| Facility | | $712.09 | $1,135.68 | $2,353.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.52 / $510.66 / $3,077.84
| Facility | | $258.52 | $510.66 | $3,077.84 |
- 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 |