- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.53 / $824.00 / $5,634.00
| Facility | | $187.53 | $824.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $5,757.57 / $8,240.00
| Facility | | $800.00 | $5,757.57 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.51 / $226.24 / $261.05
| Facility | | $177.51 | $226.24 | $261.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.03 / $761.00 / $1,158.10
| Facility | | $217.03 | $761.00 | $1,158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |