- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.66 / $374.92 / $2,042.00
| Facility | | $181.66 | $374.92 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.22 / $1,918.16 / $4,193.72
| Facility | | $398.22 | $1,918.16 | $4,193.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.27 / $1,367.63 / $3,290.01
| Facility | | $876.27 | $1,367.63 | $3,290.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.36 / $1,177.00 / $2,590.56
| Facility | | $759.36 | $1,177.00 | $2,590.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.02 / $539.16 / $1,107.58
| Facility | | $261.02 | $539.16 | $1,107.58 |
- 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 |