- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.19 / $1,245.00 / $8,413.00
| Facility | | $494.19 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.19 / $583.00 / $909.89
| Facility | | $494.19 | $583.00 | $909.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.00 / $832.00 / $1,928.00
| Facility | | $361.00 | $832.00 | $1,928.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $3,574.44 / $3,574.44
| Facility | | $2,000.00 | $3,574.44 | $3,574.44 |