- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.47 / $1,300.00 / $3,685.00
| Facility | | $421.47 | $1,300.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,950.24 / $8,241.64 / $12,324.51
| Facility | | $3,950.24 | $8,241.64 | $12,324.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $280.23
| Facility | | $40.00 | $40.00 | $280.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |