- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $218.78 / $346.74
| Facility | | $100.00 | $218.78 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $47.86 / $186.21
| Facility | | $26.30 | $47.86 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $125.89 / $257.04
| Facility | | $60.26 | $125.89 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $64.57 / $162.18
| Facility | | $39.81 | $64.57 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |