- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.07 / $1,230.00 / $3,500.00
| Facility | | $174.07 | $1,230.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.84 / $512.86 / $1,971.72
| Facility | | $200.84 | $512.86 | $1,971.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $87.34 / $125.79
| Facility | | $40.00 | $87.34 | $125.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.22 / $488.00 / $575.00
| Facility | | $176.22 | $488.00 | $575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $510.92 / $1,211.00
| Facility | | $194.00 | $510.92 | $1,211.00 |