- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.49 / $1,520.00 / $3,685.00
| Facility | | $557.49 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.22 / $2,728.26 / $4,442.46
| Facility | | $1,308.22 | $2,728.26 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $417.11
| Facility | | $40.00 | $40.00 | $417.11 |
- 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 |