- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.25 / $293.25 / $293.25
| Facility | | $293.25 | $293.25 | $293.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $3,743.71 / $11,925.72
| Facility | | $1.00 | $3,743.71 | $11,925.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.23 / $922.10 / $2,218.25
| Facility | | $650.23 | $922.10 | $2,218.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.59 / $843.02 / $1,746.65
| Facility | | $528.59 | $843.02 | $1,746.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.39 / $550.73 / $2,400.00
| Facility | | $463.39 | $550.73 | $2,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |