- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.23 / $1,230.00 / $3,500.00
| Facility | | $277.23 | $1,230.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.25 / $1,392.74 / $2,723.75
| Facility | | $746.25 | $1,392.74 | $2,723.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $75.87
| Facility | | $40.00 | $40.00 | $75.87 |
- 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 |