- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $120.23 / $120.23
| Facility | | $100.00 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $758.58 / $1,819.70
| Facility | | $218.78 | $758.58 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $1,047.13
| Facility | | $316.23 | $446.68 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $831.76
| Facility | | $338.84 | $426.58 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $190.55 / $363.08
| Facility | | $100.00 | $190.55 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |