- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.67 / $275.89 / $2,042.00
| Facility | | $86.67 | $275.89 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.90 / $1,199.58 / $2,500.33
| Facility | | $177.90 | $1,199.58 | $2,500.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.94 / $951.96 / $2,290.08
| Facility | | $609.94 | $951.96 | $2,290.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.71 / $870.32 / $1,803.21
| Facility | | $545.71 | $870.32 | $1,803.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.89 / $248.88 / $709.80
| Facility | | $91.89 | $248.88 | $709.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |