- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.80 / $2,640.00 / $5,506.00
| Facility | | $547.80 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,541.29 / $2,700.74
| Facility | | $412.80 | $1,541.29 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.00 / $550.34 / $901.73
| Facility | | $333.00 | $550.34 | $901.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.20 / $210.80 / $528.92
| Facility | | $68.20 | $210.80 | $528.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.00 / $1,525.00 / $3,051.00
| Facility | | $703.00 | $1,525.00 | $3,051.00 |