- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $1,227.00 / $3,552.00
| Facility | | $425.00 | $1,227.00 | $3,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.23 / $310.23 / $310.23
| Facility | | $310.23 | $310.23 | $310.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $650.00 / $4,330.50
| Facility | | $300.00 | $650.00 | $4,330.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.00 / $400.00 / $3,711.00
| Facility | | $360.00 | $400.00 | $3,711.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,044.00 / $1,716.00
| Facility | | $400.00 | $1,044.00 | $1,716.00 |