- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.74 / $420.32 / $2,525.00
| Facility | | $169.74 | $420.32 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.58 / $3,285.55 / $7,238.46
| Facility | | $360.58 | $3,285.55 | $7,238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.51 / $1,495.43 / $3,597.47
| Facility | | $1,054.51 | $1,495.43 | $3,597.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.24 / $1,367.18 / $2,832.65
| Facility | | $857.24 | $1,367.18 | $2,832.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.52 / $707.88 / $3,307.00
| Facility | | $270.52 | $707.88 | $3,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |