- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $1,412.54
| Facility | | $89.13 | $89.13 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $120.23
| Facility | | $100.00 | $100.00 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $1,318.26
| Facility | | $158.49 | $158.49 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,995.26
| Facility | | $691.83 | $691.83 | $1,995.26 |