- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,956.00 / $6,329.00
| Facility | | $1,170.00 | $2,956.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.61 / $439.25 / $723.65
| Facility | | $110.61 | $439.25 | $723.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.46 / $201.46 / $201.46
| Facility | | $201.46 | $201.46 | $201.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.21 / $244.74 / $604.66
| Facility | | $114.21 | $244.74 | $604.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $1,711.00 / $3,268.00
| Facility | | $1,086.00 | $1,711.00 | $3,268.00 |