- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.00 / $1,273.00 / $3,500.00
| Facility | | $379.00 | $1,273.00 | $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
- $150.33 / $1,138.30 / $1,138.30
| Facility | | $150.33 | $1,138.30 | $1,138.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.20 / $525.00 / $1,141.00
| Facility | | $289.20 | $525.00 | $1,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $1,646.00 / $4,010.00
| Facility | | $488.00 | $1,646.00 | $4,010.00 |