- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.75 / $618.97 / $3,776.00
| Facility | | $253.75 | $618.97 | $3,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.19 / $523.02 / $973.00
| Facility | | $212.19 | $523.02 | $973.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.94 / $157.94 / $202.96
| Facility | | $157.94 | $157.94 | $202.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.16 / $173.00 / $310.37
| Facility | | $139.16 | $173.00 | $310.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.00 / $1,138.00 / $2,922.00
| Facility | | $384.00 | $1,138.00 | $2,922.00 |