- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,544.00 / $3,685.00
| Facility | | $443.91 | $1,544.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.94 / $3,070.26 / $4,786.85
| Facility | | $1,563.94 | $3,070.26 | $4,786.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $221.71 / $831.66
| Facility | | $40.00 | $221.71 | $831.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.76 / $525.00 / $1,298.00
| Facility | | $436.76 | $525.00 | $1,298.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,429.00 / $4,010.00
| Facility | | $464.00 | $1,429.00 | $4,010.00 |