- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.27 / $1,300.00 / $3,685.00
| Facility | | $436.27 | $1,300.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.00 / $2,001.00 / $2,763.61
| Facility | | $885.00 | $2,001.00 | $2,763.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.75 / $292.75 / $292.75
| Facility | | $292.75 | $292.75 | $292.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |