- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.18 / $2,418.00 / $4,509.00
| Facility | | $495.18 | $2,418.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.57 / $9,645.70 / $13,548.82
| Facility | | $1,192.57 | $9,645.70 | $13,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $211.86
| Facility | | $40.00 | $40.00 | $211.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.00 / $669.00 / $1,817.00
| Facility | | $211.00 | $669.00 | $1,817.00 |