- 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 / $2,178.07 / $3,606.87
| Facility | | $1,081.25 | $2,178.07 | $3,606.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $208.61 / $831.66
| Facility | | $40.00 | $208.61 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.26 / $650.00 / $1,197.32
| Facility | | $269.26 | $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 |