- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.23 / $1,172.00 / $3,500.00
| Facility | | $205.23 | $1,172.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.16 / $1,332.66 / $1,953.36
| Facility | | $541.16 | $1,332.66 | $1,953.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.36 / $673.36 / $673.36
| Facility | | $673.36 | $673.36 | $673.36 |
- 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
- $341.00 / $1,086.00 / $2,755.00
| Facility | | $341.00 | $1,086.00 | $2,755.00 |