- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $3,576.00 / $7,500.00
| Facility | | $760.00 | $3,576.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.20 / $674.17 / $912.98
| Facility | | $606.20 | $674.17 | $912.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.68 / $1,266.68 / $1,266.68
| Facility | | $1,266.68 | $1,266.68 | $1,266.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.96 / $575.00 / $3,910.00
| Facility | | $347.96 | $575.00 | $3,910.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $610.00 / $1,883.00
| Facility | | $100.00 | $610.00 | $1,883.00 |