- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.26 / $1,888.10 / $3,638.00
| Facility | | $272.26 | $1,888.10 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,597.22 / $6,373.77 / $12,643.17
| Facility | | $3,597.22 | $6,373.77 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.27 / $1,239.82 / $2,982.56
| Facility | | $874.27 | $1,239.82 | $2,982.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.72 / $1,133.50 / $2,348.48
| Facility | | $710.72 | $1,133.50 | $2,348.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.69 / $598.92 / $4,746.00
| Facility | | $393.69 | $598.92 | $4,746.00 |
- 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 |