- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.30 / $319.22 / $2,384.00
| Facility | | $197.30 | $319.22 | $2,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.45 / $805.93 / $1,640.27
| Facility | | $317.45 | $805.93 | $1,640.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.98 / $1,150.24 / $2,767.06
| Facility | | $736.98 | $1,150.24 | $2,767.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.66 / $1,014.14 / $2,178.79
| Facility | | $638.66 | $1,014.14 | $2,178.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.45 / $436.14 / $887.64
| Facility | | $256.45 | $436.14 | $887.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.00 / $1,727.00 / $2,883.00
| Facility | | $133.00 | $1,727.00 | $2,883.00 |