- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.00 / $1,300.00 / $3,500.00
| Facility | | $338.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.02 / $2,612.23 / $3,770.31
| Facility | | $1,254.02 | $2,612.23 | $3,770.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.91 / $1,266.89 / $1,266.89
| Facility | | $132.91 | $1,266.89 | $1,266.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.03 / $525.00 / $1,197.32
| Facility | | $176.03 | $525.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,429.00 / $4,010.00
| Facility | | $464.00 | $1,429.00 | $4,010.00 |