- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.83 / $906.35 / $2,384.00
| Facility | | $108.83 | $906.35 | $2,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.09 / $2,993.28 / $6,762.24
| Facility | | $559.09 | $2,993.28 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,074.73 / $3,238.11 / $7,789.72
| Facility | | $2,074.73 | $3,238.11 | $7,789.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.10 / $2,854.95 / $6,133.64
| Facility | | $1,665.10 | $2,854.95 | $6,133.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.30 / $348.32 / $2,521.77
| Facility | | $144.30 | $348.32 | $2,521.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |