- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.42 / $2,258.00 / $7,602.00
| Facility | | $369.42 | $2,258.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $145.00 / $623.00
| Facility | | $108.00 | $145.00 | $623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $354.87 / $688.09
| Facility | | $55.00 | $354.87 | $688.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |