- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.82 / $4,747.82 / $5,572.25
| Facility | | $330.82 | $4,747.82 | $5,572.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.24 / $685.00 / $1,226.89
| Facility | | $453.24 | $685.00 | $1,226.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.20 / $703.26 / $1,044.99
| Facility | | $206.20 | $703.26 | $1,044.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,877.00
| Facility | | $393.00 | $650.00 | $4,877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.20 / $1,192.20 / $16,394.00
| Facility | | $1,192.20 | $1,192.20 | $16,394.00 |