- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $3,000.00 / $3,100.00
| Facility | | $737.00 | $3,000.00 | $3,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.30 / $324.07 / $1,480.73
| Facility | | $165.30 | $324.07 | $1,480.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.00 / $68.25 / $68.25
| Facility | | $15.00 | $68.25 | $68.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Facility | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.47 / $54.05 / $815.57
| Facility | | $34.47 | $54.05 | $815.57 |