- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $3,801.89 / $5,623.41
| Facility | | $123.03 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $323.59
| Facility | | $165.96 | $165.96 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $114.82 / $128.82
| Facility | | $109.65 | $114.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $758.58
| Facility | | $204.17 | $204.17 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,890.45 / $6,456.54
| Facility | | $1,000.00 | $3,890.45 | $6,456.54 |