- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,524.00 / $3,685.00
| Facility | | $443.91 | $1,524.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.11 / $2,529.78 / $3,592.28
| Facility | | $1,365.11 | $2,529.78 | $3,592.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $90.10 / $90.10
| Facility | | $40.00 | $90.10 | $90.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.92 / $124.92 / $124.92
| Facility | | $124.92 | $124.92 | $124.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,643.00 / $4,123.00
| Facility | | $470.00 | $1,643.00 | $4,123.00 |