- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.56 / $1,230.00 / $3,500.00
| Facility | | $385.56 | $1,230.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.06 / $1,746.33 / $3,298.63
| Facility | | $877.06 | $1,746.33 | $3,298.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.40 / $1,563.89 / $1,563.89
| Facility | | $201.40 | $1,563.89 | $1,563.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.26 / $525.00 / $981.36
| Facility | | $399.26 | $525.00 | $981.36 |
- 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 |