- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.81 / $2,758.00 / $5,432.00
| Facility | | $866.81 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,124.02 / $21,784.78 / $35,706.48
| Facility | | $12,124.02 | $21,784.78 | $35,706.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,656.00 / $8,813.00 / $19,124.00
| Facility | | $5,656.00 | $8,813.00 | $19,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.00 / $9,403.00 / $21,198.00
| Facility | | $1,215.00 | $9,403.00 | $21,198.00 |