- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,520.00 / $3,685.00
| Facility | | $443.91 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.94 / $3,044.83 / $4,786.85
| Facility | | $1,563.94 | $3,044.83 | $4,786.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $200.48 / $831.66
| Facility | | $40.00 | $200.48 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.07 / $525.00 / $1,298.00
| Facility | | $258.07 | $525.00 | $1,298.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $1,646.00 / $4,010.00
| Facility | | $488.00 | $1,646.00 | $4,010.00 |