- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,511.89 / $7,585.78
| Facility | | $630.96 | $2,511.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $1,000.00
| Facility | | $54.95 | $56.23 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,584.89 / $5,370.32
| Facility | | $162.18 | $1,584.89 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $177.83 / $346.74
| Facility | | $141.25 | $177.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,047.13 / $2,691.53
| Facility | | $154.88 | $1,047.13 | $2,691.53 |