- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,520.00 / $3,685.00
| Facility | | $400.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.70 / $1,648.03 / $2,530.08
| Facility | | $795.70 | $1,648.03 | $2,530.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $206.75 / $609.16
| Facility | | $40.00 | $206.75 | $609.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.44 / $650.00 / $877.00
| Facility | | $400.44 | $650.00 | $877.00 |
- 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 |