- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.56 / $523.12 / $1,400.00
| Facility | | $336.56 | $523.12 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.77 / $405.12 / $441.38
| Facility | | $368.77 | $405.12 | $441.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.32 / $591.32 / $591.32
| Facility | | $591.32 | $591.32 | $591.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,504.70 / $3,504.70 / $3,504.70
| Facility | | $3,504.70 | $3,504.70 | $3,504.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,450.00 / $2,450.00
| Facility | | $2,450.00 | $2,450.00 | $2,450.00 |