- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.00 / $687.00 / $2,480.00
| Facility | | $481.00 | $687.00 | $2,480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.81 / $860.93 / $2,167.33
| Facility | | $341.81 | $860.93 | $2,167.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.00 / $487.00 / $600.00
| Facility | | $335.00 | $487.00 | $600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,378.00 / $1,378.00 / $1,378.00
| Facility | | $1,378.00 | $1,378.00 | $1,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $480.00 / $480.00
| Facility | | $480.00 | $480.00 | $480.00 |