- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.54 / $140.54 / $2,168.00
| Facility | | $140.54 | $140.54 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.51 / $5,483.97 / $12,389.06
| Facility | | $700.51 | $5,483.97 | $12,389.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.59 / $502.86 / $1,209.69
| Facility | | $354.59 | $502.86 | $1,209.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.26 / $459.73 / $952.51
| Facility | | $288.26 | $459.73 | $952.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.74 / $300.61 / $8,313.00
| Facility | | $202.74 | $300.61 | $8,313.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |