- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.39 / $1,520.00 / $3,685.00
| Facility | | $184.39 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.30 / $3,460.72 / $4,805.87
| Facility | | $1,908.30 | $3,460.72 | $4,805.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $600.00
| Facility | | $600.00 | $600.00 | $600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.00 / $1,049.00 / $2,271.00
| Facility | | $341.00 | $1,049.00 | $2,271.00 |