- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.65 / $180.65 / $2,525.00
| Facility | | $180.65 | $180.65 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.90 / $3,291.97 / $6,861.58
| Facility | | $385.90 | $3,291.97 | $6,861.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.17 / $633.04 / $1,522.89
| Facility | | $446.17 | $633.04 | $1,522.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.61 / $578.76 / $1,199.13
| Facility | | $405.61 | $578.76 | $1,199.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.73 / $324.00 / $4,708.43
| Facility | | $195.73 | $324.00 | $4,708.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |