- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.93 / $1,791.00 / $6,681.00
| Facility | | $325.93 | $1,791.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $150.00 / $4,580.00
| Facility | | $108.00 | $150.00 | $4,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.11 / $257.43 / $578.66
| Facility | | $194.11 | $257.43 | $578.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,002.54 / $1,022.40
| Facility | | $55.00 | $1,002.54 | $1,022.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $814.00 / $2,495.00
| Facility | | $296.00 | $814.00 | $2,495.00 |