- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $3,162.28
| Facility | | $794.33 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $363.08 / $1,584.89
| Facility | | $28.18 | $363.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $3,981.07 / $4,168.69
| Facility | | $100.00 | $3,981.07 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,096.48
| Facility | | $851.14 | $851.14 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,096.48
| Facility | | $851.14 | $851.14 | $1,096.48 |