- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.17 / $3,312.00 / $9,159.45
| Facility | | $346.17 | $3,312.00 | $9,159.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.45 / $3,244.31 / $7,034.84
| Facility | | $906.45 | $3,244.31 | $7,034.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.45 / $1,264.91 / $3,042.90
| Facility | | $810.45 | $1,264.91 | $3,042.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.33 / $1,154.31 / $2,395.98
| Facility | | $702.33 | $1,154.31 | $2,395.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.62 / $737.77 / $3,007.01
| Facility | | $375.62 | $737.77 | $3,007.01 |
- 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 |