- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $1,300.00 / $3,500.00
| Facility | | $297.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.70 / $1,636.18 / $2,500.11
| Facility | | $795.70 | $1,636.18 | $2,500.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.05 / $711.40 / $711.40
| Facility | | $149.05 | $711.40 | $711.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.77 / $525.00 / $877.00
| Facility | | $191.77 | $525.00 | $877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,600.00 / $3,765.00
| Facility | | $500.00 | $1,600.00 | $3,765.00 |