- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.69 / $824.00 / $5,634.00
| Facility | | $138.69 | $824.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $5,790.87 / $8,240.00
| Facility | | $970.00 | $5,790.87 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.50 / $205.23 / $307.85
| Facility | | $150.50 | $205.23 | $307.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |