- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.32 / $3,500.00 / $8,842.40
| Facility | | $735.32 | $3,500.00 | $8,842.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,458.87 / $10,052.95 / $18,810.62
| Facility | | $5,458.87 | $10,052.95 | $18,810.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $397.59 / $6,886.49
| Facility | | $40.00 | $397.59 | $6,886.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $766.05 / $9,914.36
| Facility | | $488.00 | $766.05 | $9,914.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $5,780.00 / $12,805.00
| Facility | | $1,100.00 | $5,780.00 | $12,805.00 |