- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.75 / $255.40 / $2,168.00
| Facility | | $192.75 | $255.40 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.04 / $4,469.87 / $10,098.06
| Facility | | $403.04 | $4,469.87 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.45 / $973.46 / $2,341.80
| Facility | | $686.45 | $973.46 | $2,341.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.03 / $889.98 / $1,843.94
| Facility | | $558.03 | $889.98 | $1,843.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.20 / $434.33 / $4,746.00
| Facility | | $307.20 | $434.33 | $4,746.00 |
- 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 |