- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.49 / $1,520.00 / $3,728.00
| Facility | | $144.49 | $1,520.00 | $3,728.00 |
- 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 / $85.02 / $85.02
| Facility | | $40.00 | $85.02 | $85.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.30 / $119.30 / $119.30
| Facility | | $119.30 | $119.30 | $119.30 |
- 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 |