- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.35 / $1,236.00 / $3,884.00
| Facility | | $211.35 | $1,236.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.96 / $399.72 / $959.86
| Facility | | $193.96 | $399.72 | $959.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $55.51 / $55.51
| Facility | | $40.00 | $55.51 | $55.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.77 / $119.77 / $119.77
| Facility | | $119.77 | $119.77 | $119.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $580.00 / $1,506.00
| Facility | | $210.00 | $580.00 | $1,506.00 |