- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.22 / $258.89 / $2,168.00
| Facility | | $108.22 | $258.89 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.72 / $1,585.78 / $3,239.20
| Facility | | $493.72 | $1,585.78 | $3,239.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.21 / $894.63 / $2,152.16
| Facility | | $573.21 | $894.63 | $2,152.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.84 / $817.91 / $1,694.61
| Facility | | $512.84 | $817.91 | $1,694.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.54 / $295.08 / $751.07
| Facility | | $147.54 | $295.08 | $751.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |