- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.15 / $455.01 / $2,168.00
| Facility | | $367.15 | $455.01 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.05 / $8,328.96 / $18,388.59
| Facility | | $2,490.05 | $8,328.96 | $18,388.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.10 / $1,642.35 / $3,950.89
| Facility | | $1,158.10 | $1,642.35 | $3,950.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.46 / $1,501.50 / $3,110.94
| Facility | | $941.46 | $1,501.50 | $3,110.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.70 / $786.22 / $4,746.00
| Facility | | $578.70 | $786.22 | $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 |