- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.00 / $1,520.00 / $3,593.00
| Facility | | $398.00 | $1,520.00 | $3,593.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.48 / $1,405.46 / $2,234.36
| Facility | | $675.48 | $1,405.46 | $2,234.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.44 / $458.21 / $458.21
| Facility | | $121.44 | $458.21 | $458.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.12 / $650.00 / $820.00
| Facility | | $232.12 | $650.00 | $820.00 |
- 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 |