- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.48 / $259.20 / $2,056.00
| Facility | | $88.48 | $259.20 | $2,056.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.59 / $651.47 / $921.17
| Facility | | $545.59 | $651.47 | $921.17 |
- 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
- $88.48 / $662.26 / $4,933.00
| Facility | | $88.48 | $662.26 | $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 |