- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,520.00 / $3,685.00
| Facility | | $400.00 | $1,520.00 | $3,685.00 |
- 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
- $40.00 / $203.51 / $831.66
| Facility | | $40.00 | $203.51 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.76 / $525.00 / $1,197.32
| Facility | | $263.76 | $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 |