- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.37 / $506.10 / $2,168.00
| Facility | | $218.37 | $506.10 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.54 / $2,656.15 / $5,761.70
| Facility | | $475.54 | $2,656.15 | $5,761.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,804.79 / $4,341.67
| Facility | | $1,156.36 | $1,804.79 | $4,341.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.06 / $1,591.23 / $3,418.64
| Facility | | $928.06 | $1,591.23 | $3,418.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.24 / $647.40 / $1,427.23
| Facility | | $278.24 | $647.40 | $1,427.23 |
- 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 |