- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.00 / $1,520.00 / $3,685.00
| Facility | | $389.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $2,100.31 / $3,571.74
| Facility | | $1,081.25 | $2,100.31 | $3,571.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.45 / $1,438.71 / $1,438.71
| Facility | | $125.45 | $1,438.71 | $1,438.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.56 / $650.00 / $1,197.32
| Facility | | $161.56 | $650.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,791.00 / $4,251.00
| Facility | | $500.00 | $1,791.00 | $4,251.00 |