- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.63 / $2,650.20 / $7,993.00
| Facility | | $149.63 | $2,650.20 | $7,993.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.63 / $317.93 / $458.84
| Facility | | $149.63 | $317.93 | $458.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.55 / $873.55 / $26,542.00
| Facility | | $873.55 | $873.55 | $26,542.00 |