- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.27 / $310.27 / $2,845.00
| Facility | | $310.27 | $310.27 | $2,845.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.02 / $5,483.97 / $12,389.06
| Facility | | $598.02 | $5,483.97 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.10 / $1,127.55 / $2,712.47
| Facility | | $795.10 | $1,127.55 | $2,712.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.36 / $1,030.84 / $2,135.80
| Facility | | $646.36 | $1,030.84 | $2,135.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.38 / $638.27 / $7,770.00
| Facility | | $447.38 | $638.27 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,289.00 / $8,193.00
| Facility | | $2,740.00 | $4,289.00 | $8,193.00 |