- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.11 / $873.94 / $2,168.00
| Facility | | $212.11 | $873.94 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.05 / $3,285.55 / $7,238.46
| Facility | | $457.05 | $3,285.55 | $7,238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,139.35 / $3,033.86 / $7,298.37
| Facility | | $2,139.35 | $3,033.86 | $7,298.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,739.14 / $2,773.68 / $5,746.75
| Facility | | $1,739.14 | $2,773.68 | $5,746.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.27 / $1,476.96 / $4,746.00
| Facility | | $368.27 | $1,476.96 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |