- 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
- $79.20 / $312.83 / $518.16
| Facility | | $79.20 | $312.83 | $518.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.70 / $112.70 / $112.70
| Facility | | $112.70 | $112.70 | $112.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.25 / $182.34 / $556.30
| Facility | | $65.25 | $182.34 | $556.30 |
- 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 |