- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.92 / $1,230.00 / $3,500.00
| Facility | | $306.92 | $1,230.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.93 / $638.55 / $1,447.53
| Facility | | $300.93 | $638.55 | $1,447.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $81.40
| Facility | | $40.00 | $40.00 | $81.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.00 / $1,086.00 / $2,755.00
| Facility | | $341.00 | $1,086.00 | $2,755.00 |