- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.08 / $702.00 / $14,890.77
| Facility | | $149.08 | $702.00 | $14,890.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.85 / $258.85 / $258.85
| Facility | | $258.85 | $258.85 | $258.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.08 / $629.51 / $1,009.13
| Facility | | $149.08 | $629.51 | $1,009.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,376.00 / $3,517.00
| Facility | | $405.00 | $2,376.00 | $3,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,121.25 / $1,121.25
| Facility | | $55.00 | $1,121.25 | $1,121.25 |