- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.21 / $2,562.00 / $4,050.00
| Facility | | $406.21 | $2,562.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.42 / $9,428.39 / $13,243.57
| Facility | | $2,054.42 | $9,428.39 | $13,243.57 |
- 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
- $1,200.00 / $5,780.00 / $12,353.00
| Facility | | $1,200.00 | $5,780.00 | $12,353.00 |