- 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 / $314.52 / $518.16
| Facility | | $79.20 | $314.52 | $518.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.43 / $257.43 / $257.43
| Facility | | $257.43 | $257.43 | $257.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.60 / $543.65 / $1,069.42
| Facility | | $163.60 | $543.65 | $1,069.42 |
- 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 |