- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,892.00 / $5,420.00
| Facility | | $900.00 | $2,892.00 | $5,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,588.66 / $7,750.58 / $11,965.29
| Facility | | $3,588.66 | $7,750.58 | $11,965.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,603.12 / $2,807.66
| Facility | | $40.00 | $1,603.12 | $2,807.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $1,595.00 / $4,042.13
| Facility | | $725.00 | $1,595.00 | $4,042.13 |
- 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 |