- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.26 / $1,172.00 / $3,685.00
| Facility | | $434.26 | $1,172.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.53 / $1,106.50 / $1,534.71
| Facility | | $601.53 | $1,106.50 | $1,534.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $309.32
| Facility | | $40.00 | $40.00 | $309.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $1,100.00 / $1,100.00
| Facility | | $1,100.00 | $1,100.00 | $1,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.00 / $1,086.00 / $2,755.00
| Facility | | $341.00 | $1,086.00 | $2,755.00 |