- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.85 / $1,386.00 / $5,634.00
| Facility | | $319.85 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.00 / $4,320.00 / $8,230.00
| Facility | | $856.00 | $4,320.00 | $8,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.52 / $380.48 / $439.02
| Facility | | $298.52 | $380.48 | $439.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.36 / $166.36 / $166.36
| Facility | | $166.36 | $166.36 | $166.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $2,252.00 / $4,426.00
| Facility | | $933.00 | $2,252.00 | $4,426.00 |