- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.70 / $704.58 / $5,634.00
| Facility | | $62.70 | $704.58 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.82 / $60.82 / $117.38
| Facility | | $60.82 | $60.82 | $117.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.42 / $84.31 / $135.50
| Facility | | $61.42 | $84.31 | $135.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.70 / $112.70 / $112.70
| Facility | | $112.70 | $112.70 | $112.70 |
- 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 |