- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $263.03 / $316.23
| Facility | | $104.71 | $263.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $16.98 / $44.67
| Facility | | $12.02 | $16.98 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $281.84
| Facility | | $75.86 | $100.00 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $316.23
| Facility | | $75.86 | $100.00 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $89.13 / $204.17
| Facility | | $75.86 | $89.13 | $204.17 |