- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.57 / $171.57 / $2,525.00
| Facility | | $171.57 | $171.57 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.02 / $8,965.31 / $20,319.91
| Facility | | $903.02 | $8,965.31 | $20,319.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.02 / $625.88 / $1,505.65
| Facility | | $401.02 | $625.88 | $1,505.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.52 / $571.16 / $1,185.55
| Facility | | $347.52 | $571.16 | $1,185.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.40 / $340.62 / $2,100.00
| Facility | | $181.40 | $340.62 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |