- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.83 / $2,056.00 / $4,933.00
| Facility | | $46.83 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.72 / $639.69 / $904.51
| Facility | | $535.72 | $639.69 | $904.51 |
- 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
- $118.93 / $2,056.00 / $4,933.00
| Facility | | $118.93 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,438.00 / $2,029.00
| Facility | | $464.00 | $1,438.00 | $2,029.00 |