- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $245.47 / $512.86
| Facility | | $141.25 | $245.47 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $89.13 / $100.00
| Facility | | $56.23 | $89.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $213.80 / $524.81
| Facility | | $75.86 | $213.80 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $33.11 / $302.00
| Facility | | $23.44 | $33.11 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $194.98 / $524.81
| Facility | | $75.86 | $194.98 | $524.81 |