- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,520.00 / $3,593.00
| Facility | | $400.00 | $1,520.00 | $3,593.00 |
- 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
- $40.00 / $144.44 / $831.66
| Facility | | $40.00 | $144.44 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.18 / $650.00 / $1,197.32
| Facility | | $277.18 | $650.00 | $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 |