- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.47 / $442.37 / $1,200.00
| Facility | | $277.47 | $442.37 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.51 / $343.27 / $374.00
| Facility | | $313.51 | $343.27 | $374.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.96 / $342.96 / $342.96
| Facility | | $342.96 | $342.96 | $342.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,460.04 / $9,460.04 / $9,460.04
| Facility | | $9,460.04 | $9,460.04 | $9,460.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.56 / $672.56 / $672.56
| Facility | | $672.56 | $672.56 | $672.56 |