- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.95 / $1,520.00 / $3,728.00
| Facility | | $476.95 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,410.03 / $17,289.41 / $39,984.65
| Facility | | $8,410.03 | $17,289.41 | $39,984.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $302.27
| Facility | | $40.00 | $40.00 | $302.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |