- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.26 / $413.83 / $2,168.00
| Facility | | $158.26 | $413.83 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.16 / $1,918.16 / $4,193.72
| Facility | | $344.16 | $1,918.16 | $4,193.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.45 / $1,499.02 / $3,606.09
| Facility | | $960.45 | $1,499.02 | $3,606.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.82 / $1,321.64 / $2,839.44
| Facility | | $770.82 | $1,321.64 | $2,839.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.68 / $491.42 / $1,229.63
| Facility | | $211.68 | $491.42 | $1,229.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,523.00 / $6,275.00
| Facility | | $875.00 | $2,523.00 | $6,275.00 |