- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.11 / $590.55 / $2,384.00
| Facility | | $152.11 | $590.55 | $2,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.92 / $3,084.88 / $6,762.24
| Facility | | $788.92 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.36 / $2,130.87 / $5,126.10
| Facility | | $1,270.36 | $2,130.87 | $5,126.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.73 / $1,878.73 / $4,036.30
| Facility | | $1,095.73 | $1,878.73 | $4,036.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.32 / $494.37 / $1,691.37
| Facility | | $204.32 | $494.37 | $1,691.37 |
- 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 |