- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.57 / $631.26 / $2,168.00
| Facility | | $212.57 | $631.26 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.80 / $1,918.16 / $4,193.72
| Facility | | $459.80 | $1,918.16 | $4,193.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.00 / $2,229.38 / $5,482.40
| Facility | | $1,316.00 | $2,229.38 | $5,482.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.00 / $1,875.56 / $4,316.85
| Facility | | $1,177.00 | $1,875.56 | $4,316.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.73 / $672.51 / $1,747.68
| Facility | | $304.73 | $672.51 | $1,747.68 |
- 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 |