- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.86 / $362.44 / $2,168.00
| Facility | | $285.86 | $362.44 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.27 / $5,677.23 / $12,389.06
| Facility | | $608.27 | $5,677.23 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.12 / $1,309.09 / $3,149.22
| Facility | | $923.12 | $1,309.09 | $3,149.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.43 / $1,196.83 / $2,479.69
| Facility | | $750.43 | $1,196.83 | $2,479.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.57 / $612.52 / $2,097.00
| Facility | | $446.57 | $612.52 | $2,097.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |