- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,785.73 / $3,884.00
| Facility | | $900.00 | $2,785.73 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,854.01 / $8,326.07 / $12,034.00
| Facility | | $4,854.01 | $8,326.07 | $12,034.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,736.40 / $1,736.40
| Facility | | $40.00 | $1,736.40 | $1,736.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $2,193.30
| Facility | | $488.00 | $675.00 | $2,193.30 |
- 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 |