- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.43 / $1,386.00 / $5,634.00
| Facility | | $82.43 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.88 / $165.88 / $320.14
| Facility | | $165.88 | $165.88 | $320.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.50 / $104.14 / $124.17
| Facility | | $71.50 | $104.14 | $124.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.68 / $98.68 / $450.00
| Facility | | $98.68 | $98.68 | $450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.85 / $2,252.00 / $4,426.00
| Facility | | $116.85 | $2,252.00 | $4,426.00 |