- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.41 / $349.42 / $2,525.00
| Facility | | $188.41 | $349.42 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,635.84 / $4,315.64 / $7,238.46
| Facility | | $2,635.84 | $4,315.64 | $7,238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.17 / $1,248.18 / $3,002.68
| Facility | | $880.17 | $1,248.18 | $3,002.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.51 / $1,141.14 / $2,364.31
| Facility | | $715.51 | $1,141.14 | $2,364.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.11 / $463.90 / $4,746.00
| Facility | | $290.11 | $463.90 | $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 |