- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.68 / $396.98 / $2,384.00
| Facility | | $127.68 | $396.98 | $2,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.22 / $1,577.10 / $3,221.46
| Facility | | $649.22 | $1,577.10 | $3,221.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.35 / $1,438.10 / $3,459.54
| Facility | | $857.35 | $1,438.10 | $3,459.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.50 / $1,267.93 / $2,724.05
| Facility | | $739.50 | $1,267.93 | $2,724.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.44 / $420.29 / $1,169.98
| Facility | | $184.44 | $420.29 | $1,169.98 |
- 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 |