- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.83 / $1,372.00 / $3,685.00
| Facility | | $422.83 | $1,372.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.65 / $4,490.26 / $6,449.50
| Facility | | $1,419.65 | $4,490.26 | $6,449.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $277.92
| Facility | | $40.00 | $40.00 | $277.92 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |