- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.30 / $1,339.42 / $3,685.00
| Facility | | $467.30 | $1,339.42 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.19 / $3,773.96 / $5,613.80
| Facility | | $2,238.19 | $3,773.96 | $5,613.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $326.87
| Facility | | $40.00 | $40.00 | $326.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |