- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.02 / $2,418.00 / $5,150.00
| Facility | | $692.02 | $2,418.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.29 / $5,652.17 / $10,442.46
| Facility | | $2,630.29 | $5,652.17 | $10,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $510.93
| Facility | | $40.00 | $40.00 | $510.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |