- 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
- $8,448.45 / $14,491.58 / $20,945.28
| Facility | | $8,448.45 | $14,491.58 | $20,945.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,148.78 / $1,148.78
| Facility | | $40.00 | $1,148.78 | $1,148.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,432.07
| Facility | | $488.00 | $675.00 | $1,432.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,261.00 / $7,168.00
| Facility | | $385.00 | $1,261.00 | $7,168.00 |