- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.30 / $1,520.00 / $3,685.00
| Facility | | $510.30 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.09 / $7,362.58 / $14,166.86
| Facility | | $4,062.09 | $7,362.58 | $14,166.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $388.94
| Facility | | $40.00 | $40.00 | $388.94 |
- 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 |