- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,887.00 / $5,420.00
| Facility | | $941.00 | $2,887.00 | $5,420.00 |
- 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 / $1,347.03 / $1,347.03
| Facility | | $40.00 | $1,347.03 | $1,347.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,696.76
| Facility | | $488.00 | $675.00 | $1,696.76 |
- 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 |