- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.36 / $1,520.00 / $3,728.00
| Facility | | $460.36 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,460.05 / $6,565.29 / $13,753.10
| Facility | | $3,460.05 | $6,565.29 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $334.91
| Facility | | $40.00 | $40.00 | $334.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |