- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.76 / $1,520.00 / $3,685.00
| Facility | | $432.76 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.43 / $3,716.93 / $6,777.62
| Facility | | $1,536.43 | $3,716.93 | $6,777.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $147.44 / $831.66
| Facility | | $40.00 | $147.44 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.38 / $525.00 / $1,298.00
| Facility | | $282.38 | $525.00 | $1,298.00 |
- 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 |