- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.86 / $1,230.00 / $3,500.00
| Facility | | $240.86 | $1,230.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $2,399.64 / $3,606.87
| Facility | | $1,081.25 | $2,399.64 | $3,606.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $124.98 / $831.66
| Facility | | $40.00 | $124.98 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.55 / $525.00 / $1,197.32
| Facility | | $247.55 | $525.00 | $1,197.32 |
- 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 |