- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.00 / $1,520.00 / $3,685.00
| Facility | | $398.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $2,149.32 / $3,360.71
| Facility | | $1,081.25 | $2,149.32 | $3,360.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.36 / $1,374.83 / $1,374.83
| Facility | | $158.36 | $1,374.83 | $1,374.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.80 / $650.00 / $1,197.32
| Facility | | $204.80 | $650.00 | $1,197.32 |
- 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 |