- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,236.00 / $3,500.00
| Facility | | $497.00 | $1,236.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $4,539.27 / $6,981.81
| Facility | | $1,753.58 | $4,539.27 | $6,981.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $414.62 / $1,345.41
| Facility | | $40.00 | $414.62 | $1,345.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $535.00 / $1,936.96
| Facility | | $488.00 | $535.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |