- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.00 / $536.00 / $545.00
| Facility | | $536.00 | $536.00 | $545.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.78 / $130.16 / $494.54
| Facility | | $86.78 | $130.16 | $494.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.00 / $2,146.00 / $3,929.00
| Facility | | $1,833.00 | $2,146.00 | $3,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.00 / $77.00 / $77.00
| Facility | | $77.00 | $77.00 | $77.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $120.00 / $345.40
| Facility | | $100.00 | $120.00 | $345.40 |