- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.27 / $2,844.00 / $5,905.00
| Facility | | $902.27 | $2,844.00 | $5,905.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,931.56 / $12,218.93 / $16,560.62
| Facility | | $3,931.56 | $12,218.93 | $16,560.62 |
- 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
- $385.00 / $1,309.00 / $7,168.00
| Facility | | $385.00 | $1,309.00 | $7,168.00 |