- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.14 / $2,065.00 / $6,031.81
| Facility | | $126.14 | $2,065.00 | $6,031.81 |
- 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
- $342.80 / $486.14 / $1,169.46
| Facility | | $342.80 | $486.14 | $1,169.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.67 / $444.44 / $920.84
| Facility | | $278.67 | $444.44 | $920.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.33 / $283.83 / $6,740.00
| Facility | | $209.33 | $283.83 | $6,740.00 |
- 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 |