- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.55 / $993.63 / $2,168.00
| Facility | | $78.55 | $993.63 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.72 / $2,993.28 / $6,762.24
| Facility | | $397.72 | $2,993.28 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.19 / $3,546.28 / $8,531.04
| Facility | | $2,114.19 | $3,546.28 | $8,531.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.56 / $3,126.65 / $6,717.36
| Facility | | $1,823.56 | $3,126.65 | $6,717.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.67 / $892.00 / $2,730.27
| Facility | | $105.67 | $892.00 | $2,730.27 |
- 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 |