- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.21 / $1,850.00 / $3,945.00
| Facility | | $595.21 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.40 / $2,238.38 / $4,854.39
| Facility | | $1,174.40 | $2,238.38 | $4,854.39 |
- 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
- $689.00 / $689.00 / $689.00
| Facility | | $689.00 | $689.00 | $689.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |