- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.97 / $797.50 / $5,634.00
| Facility | | $63.97 | $797.50 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.28 / $70.28 / $135.63
| Facility | | $70.28 | $70.28 | $135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.83 / $95.96 / $154.22
| Facility | | $72.83 | $95.96 | $154.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.44 / $244.62 / $311.33
| Facility | | $128.44 | $244.62 | $311.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $2,174.00 / $4,426.00
| Facility | | $933.00 | $2,174.00 | $4,426.00 |