- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.54 / $165.54 / $2,168.00
| Facility | | $165.54 | $165.54 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.96 / $5,272.56 / $11,503.06
| Facility | | $801.96 | $5,272.56 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.39 / $570.94 / $1,373.47
| Facility | | $402.39 | $570.94 | $1,373.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.81 / $521.98 / $1,081.48
| Facility | | $365.81 | $521.98 | $1,081.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.63 / $282.13 / $2,296.00
| Facility | | $179.63 | $282.13 | $2,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |