- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,562.00 / $3,884.00
| Facility | | $900.00 | $2,562.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,107.94 / $10,724.53 / $18,385.55
| Facility | | $7,107.94 | $10,724.53 | $18,385.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,144.52 / $1,144.52
| Facility | | $40.00 | $1,144.52 | $1,144.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,536.49
| Facility | | $488.00 | $675.00 | $1,536.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $2,415.00 / $6,661.00
| Facility | | $689.00 | $2,415.00 | $6,661.00 |