- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,520.00 / $3,685.00
| Facility | | $443.91 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.40 / $1,295.61 / $1,819.92
| Facility | | $908.40 | $1,295.61 | $1,819.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $105.59 / $105.59
| Facility | | $40.00 | $105.59 | $105.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.04 / $261.04 / $261.04
| Facility | | $261.04 | $261.04 | $261.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $580.00 / $1,506.00
| Facility | | $210.00 | $580.00 | $1,506.00 |