- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.97 / $158.97 / $158.97
| Facility | | $158.97 | $158.97 | $158.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1,128.40 / $3,362.14
| Facility | | $1.00 | $1,128.40 | $3,362.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.65 / $510.02 / $1,226.93
| Facility | | $359.65 | $510.02 | $1,226.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.37 / $466.28 / $966.09
| Facility | | $292.37 | $466.28 | $966.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.75 / $297.26 / $1,966.00
| Facility | | $234.75 | $297.26 | $1,966.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.00 / $1,728.00 / $2,883.00
| Facility | | $1,260.00 | $1,728.00 | $2,883.00 |