- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.00 / $1,520.00 / $3,728.00
| Facility | | $453.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.11 / $2,802.16 / $4,260.34
| Facility | | $1,360.11 | $2,802.16 | $4,260.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $327.70
| Facility | | $40.00 | $40.00 | $327.70 |
- 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 |