- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.60 / $346.77 / $5,634.00
| Facility | | $34.60 | $346.77 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.68 / $34.68 / $66.93
| Facility | | $34.68 | $34.68 | $66.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.97 / $42.87 / $49.47
| Facility | | $32.97 | $42.87 | $49.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.55 / $61.55 / $61.55
| Facility | | $61.55 | $61.55 | $61.55 |
- 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 |