- 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
- $4,433.25 / $8,355.04 / $12,075.88
| Facility | | $4,433.25 | $8,355.04 | $12,075.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,197.61 / $1,197.61
| Facility | | $40.00 | $1,197.61 | $1,197.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,538.63
| Facility | | $488.00 | $675.00 | $1,538.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $4,717.00 / $10,959.00
| Facility | | $1,100.00 | $4,717.00 | $10,959.00 |