- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,941.00 / $5,506.00
| Facility | | $627.00 | $1,941.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.97 / $485.61 / $836.08
| Facility | | $138.97 | $485.61 | $836.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.68 / $228.68 / $228.68
| Facility | | $228.68 | $228.68 | $228.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.18 / $170.97 / $1,448.00
| Facility | | $128.18 | $170.97 | $1,448.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $1,423.00 / $2,114.00
| Facility | | $617.00 | $1,423.00 | $2,114.00 |