- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.75 / $1,181.00 / $7,278.00
| Facility | | $228.75 | $1,181.00 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.36 / $887.89 / $1,675.01
| Facility | | $495.36 | $887.89 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.75 / $338.30 / $405.87
| Facility | | $228.75 | $338.30 | $405.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,276.56 / $4,901.45
| Facility | | $55.00 | $1,276.56 | $4,901.45 |