- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $7,562.14
| Facility | | $1,170.00 | $2,640.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.18 / $314.45 / $518.05
| Facility | | $79.18 | $314.45 | $518.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.44 / $128.44 / $128.44
| Facility | | $128.44 | $128.44 | $128.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.37 / $153.76 / $370.70
| Facility | | $71.37 | $153.76 | $370.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |