- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,319.00 / $3,884.00
| Facility | | $400.00 | $1,319.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,607.97 / $3,312.82 / $5,168.50
| Facility | | $1,607.97 | $3,312.82 | $5,168.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.93 / $1,540.60 / $1,540.60
| Facility | | $238.93 | $1,540.60 | $1,540.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |