- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.65 / $647.47 / $5,634.00
| Facility | | $171.65 | $647.47 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $250.00 / $482.50
| Facility | | $250.00 | $250.00 | $482.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.63 / $197.22 / $295.83
| Facility | | $144.63 | $197.22 | $295.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.43 / $257.43 / $257.43
| Facility | | $257.43 | $257.43 | $257.43 |
- 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 |