- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.00 / $1,020.00 / $1,245.00
| Facility | | $651.00 | $1,020.00 | $1,245.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.86 / $466.37 / $1,711.44
| Facility | | $268.86 | $466.37 | $1,711.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,325.00 / $2,905.00
| Facility | | $1,000.00 | $1,325.00 | $2,905.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,580.80 / $2,580.80 / $20,774.34
| Facility | | $2,580.80 | $2,580.80 | $20,774.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.00 / $810.00 / $810.00
| Facility | | $810.00 | $810.00 | $810.00 |