- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,965.85 / $3,884.00
| Facility | | $900.00 | $2,965.85 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,531.09 / $14,013.50 / $20,254.29
| Facility | | $7,531.09 | $14,013.50 | $20,254.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,872.09 / $1,872.09
| Facility | | $40.00 | $1,872.09 | $1,872.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $2,418.19
| Facility | | $488.00 | $675.00 | $2,418.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,652.00 / $6,661.00
| Facility | | $746.00 | $2,652.00 | $6,661.00 |