- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $1,300.00 / $3,500.00
| Facility | | $297.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $1,947.29 / $3,606.87
| Facility | | $1,081.25 | $1,947.29 | $3,606.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.77 / $1,835.45 / $1,835.45
| Facility | | $123.77 | $1,835.45 | $1,835.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.47 / $525.00 / $1,197.32
| Facility | | $158.47 | $525.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |