- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $4,697.00
| Facility | | $762.00 | $1,958.00 | $4,697.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,790.86 / $13,722.46 / $20,104.22
| Facility | | $8,790.86 | $13,722.46 | $20,104.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,042.18 / $1,042.18
| Facility | | $40.00 | $1,042.18 | $1,042.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,281.96
| Facility | | $488.00 | $675.00 | $1,281.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $5,780.00 / $13,506.00
| Facility | | $1,100.00 | $5,780.00 | $13,506.00 |