- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.67 / $1,520.00 / $3,593.00
| Facility | | $375.67 | $1,520.00 | $3,593.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.16 / $297.89 / $604.73
| Facility | | $134.16 | $297.89 | $604.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $161.58 / $161.58
| Facility | | $40.00 | $161.58 | $161.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.45 / $650.00 / $820.00
| Facility | | $259.45 | $650.00 | $820.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.00 / $513.00 / $1,226.00
| Facility | | $177.00 | $513.00 | $1,226.00 |