- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.18 / $1,300.00 / $3,500.00
| Facility | | $437.18 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.31 / $2,075.83 / $3,627.48
| Facility | | $1,049.31 | $2,075.83 | $3,627.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $261.83 / $609.16
| Facility | | $40.00 | $261.83 | $609.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.86 / $525.00 / $1,141.00
| Facility | | $341.86 | $525.00 | $1,141.00 |
- 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 |