- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,810.20 / $4,050.00
| Facility | | $900.00 | $2,810.20 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,261.91 / $10,697.52 / $15,036.83
| Facility | | $6,261.91 | $10,697.52 | $15,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,674.37
| Facility | | $40.00 | $40.00 | $1,674.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,309.00 / $6,699.00
| Facility | | $385.00 | $1,309.00 | $6,699.00 |