- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Facility | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.26 / $194.56 / $1,228.03
| Facility | | $121.26 | $194.56 | $1,228.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.78 / $321.54 / $729.78
| Facility | | $128.78 | $321.54 | $729.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.00 / $256.00 / $369.00
| Facility | | $167.00 | $256.00 | $369.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.01 / $1,347.19 / $2,164.00
| Facility | | $770.01 | $1,347.19 | $2,164.00 |