- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.53 / $1,520.00 / $3,685.00
| Facility | | $384.53 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.06 / $491.53 / $1,521.98
| Facility | | $224.06 | $491.53 | $1,521.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $70.23
| Facility | | $40.00 | $40.00 | $70.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |