- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.00 / $1,300.00 / $5,029.89
| Facility | | $338.00 | $1,300.00 | $5,029.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.55 / $2,719.14 / $4,076.46
| Facility | | $1,336.55 | $2,719.14 | $4,076.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.46 / $1,482.04 / $1,482.04
| Facility | | $145.46 | $1,482.04 | $1,482.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- 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 |