- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.00 / $1,273.00 / $3,500.00
| Facility | | $379.00 | $1,273.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.40 / $1,295.61 / $1,819.92
| Facility | | $908.40 | $1,295.61 | $1,819.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $131.69 / $131.69
| Facility | | $40.00 | $131.69 | $131.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.31 / $308.31 / $308.31
| Facility | | $308.31 | $308.31 | $308.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $580.00 / $1,506.00
| Facility | | $210.00 | $580.00 | $1,506.00 |