- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.62 / $172.62 / $2,525.00
| Facility | | $172.62 | $172.62 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.16 / $6,024.48 / $13,610.15
| Facility | | $867.16 | $6,024.48 | $13,610.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.08 / $630.66 / $1,517.14
| Facility | | $404.08 | $630.66 | $1,517.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.17 / $575.52 / $1,194.59
| Facility | | $350.17 | $575.52 | $1,194.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.74 / $343.66 / $1,224.00
| Facility | | $178.74 | $343.66 | $1,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |